HIV prevalence, immunosuppression, and drug resistance in patients with tuberculosis in an area endemic for AIDS

Shafer, Robert W.; Chirgwin, Keith; Glatt, Aaron E.; Dahdouh, Michelle; Landesman, Sheldon; Suster, Bernard

doi:10.1097/00002030-199104000-00007

Cited by 99 publications

(47 citation statements)

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“…The virus infects and damages both CD4 [2] and antigen-processing eells [3]. The upshot of these effects is anergy to skin test antigens [4], low lymphocyte proiiferative responses to both mitogens and antigens, together with impaired production of cytokines [5], and poor control of viral [6] and bacterial pathogens such as Mycobacterium tuberculosis [7] and Streptococcus pneumoniae [8]. B cell responses are also deranged, resulting in high serum immunoglobulin levels [9] and abnormally low responses to some immunogens, including vaccines [10].…”

Section: Introductionmentioning

confidence: 99%

Immunological responses of Gambians in relation to clinical stage of HIV-2 disease

Whittle

Egboga

Todd

et al. 1993

Clinical and Experimental Immunology

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SUMMARYThis study describes a broad spectrum of cellular and antibody-mediated immune responses found in 28 asymptomatic and 37 symptomatic Gambian patients with HIV-2 infection. It shows that these responses vary according to the stage of infection as described by three clinical staging systems. The first system was a local one based on the signs used for the WHO Bangui clinical definition of AIDS, the second, suggested by WHO, was based on a performance scale, and the third was that used by the Centre for Disease Control. Asymptomatic patients had significantly lower mean CD4 counts, lymphoproliferative and interferon-gamma (IFN-y) responses and lower IgG and IgM antibody responses to keyhole limpet haemocyanin (KLH) than controls. These measurements and the size of the skin test reaction to purified protein derivative (PPD) or Candida antigen declined significantly according to the stage of infection. Mean values of the serological markers (82-microglobulin and neopterin and antibody titres to Epstein-Barr virus capsid antigen (EBVCA) rose significantly according to severity of disease. The Gambian or WHO clinical staging systems, which are easy and cheap to apply, may serve as an alternative to sophisticated and expensive immunological measurements when trying to stage disease and prediet prognosis.

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Section: Introductionmentioning

confidence: 99%

Immunological responses of Gambians in relation to clinical stage of HIV-2 disease

Whittle

Egboga

Todd

et al. 1993

Clinical and Experimental Immunology

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“…In the present study, CD4 counts were measured in 57 HIV-positive patients and ranged from 3 to 1288 cells/mm 3 …”

Section: Resultsmentioning

confidence: 92%

“…(4,6,8) Therefore, CD4 counts in peripheral blood are used to evaluate the immunological status of patients infected with the virus, and the counts thus obtained can be correlated with the clinical and radiological presentation of TB. (3,(6)(7)(8)(9)(10)(11)(12) When TB manifests in HIV-positive patients with relatively preserved immunity (CD4 > 350 cells/mm 3 ), the clinical and radiological presentation is similar to that seen in individuals who are not infected with HIV (HIV-negative individuals). (6) In patients with low CD4 counts, especially lower than 200 cell/mm 3 , TB can have an atypical presentation.…”

Section: Introductionmentioning

confidence: 99%

“…(6) In patients with low CD4 counts, especially lower than 200 cell/mm 3 , TB can have an atypical presentation. (3,(6)(7)(8)(9)(10)(11) The objective of the present study was to describe the differences in the clinical and radiological presentation of intrathoracic TB in HIV-positive and HIV-negative patients, as well as to determine the correlation between CD4 lymphocyte counts and the presence of atypical forms of TB in HIV-positive patients living in an area of high prevalence of TB/ HIV co-infection.…”

Section: Introductionmentioning

confidence: 99%

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Diferenças na apresentação clínico-radiológica da tuberculose intratorácica segundo a presença ou não de infecção por HIV

et al. 2007

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Objective: To describe the differences in the clinical and radiological presentation of tuberculosis in the presence or absence of HIV infection. Methods: A sample of 231 consecutive adults with active pulmonary tuberculosis admitted to a tuberculosis hospital were studied, assessing HIV infection, AIDS, and associated factors, as well as re-evaluating chest X-rays. Results: There were 113 HIV-positive patients (49%) Comparing the 113 HIV-positive patients (49%) to the 118 HIV-negative patients (51%), the former presented a higher frequency of atypical pulmonary tuberculosis (pulmonary lesions accompanied by intrathoracic lymph node enlargement), hematogenous tuberculosis, and pulmonary tuberculosis accompanied by superficial lymph node enlargement, as well as presenting less pulmonary cavitation. The same was found when HIV-positive patients with AIDS were compared to those without AIDS. There were no differences between the HIV-positive patients without AIDS and the HIV-negative patients. Median CD4 counts were lower in HIV-positive patients with intrathoracic lymph node enlargement and pulmonary lesions than in the HIV-positive patients with pulmonary lesions only (47 vs. tive sputum smear microscopy; having undergone HIV testing; and having undergone simple anteroposterior and lateral chest X-ray.The data were obtained through the re-evaluation of chest X-rays and the review of medical charts. The variables analyzed were as follows: age; gender; alcoholism; use of illicit drugs; corticosteroid use; duration of symptoms; presence of multifocal disease, diabetes mellitus, neoplasias, and opportunistic diseases; results of HIV testing; number of CD4 T lymphocytes; and radiological findings.Sputum smear microscopy was performed using the Ziehl-Neelsen technique. The HIV testing was performed using the ELISA method, and positive results were confirmed by Western blot. The CD4 counts were obtained using flow cytometry. Alcoholism and drug addiction were considered present when they had been registered on the medical chart by the treatment team. Multifocal disease was defined by the presence of superficial lymph node enlargement in patients with pulmonary TB.The chest X-rays were independently evaluated by two radiologists, who had no knowledge of the results of HIV testing, in order to identify the types of TB; the location of the lesions in the lung segments; and the presence of cavitary lesions, hilar or mediastinal lymph node enlargement, and pleural effusion. In case of inconsistency between the evaluations, the chest X-rays were jointly examined and, in the event of the inconsistency persisting, a third radiologist was consulted so that a consensus could be reached. The types of TB were characterized using the following classification: 1) Classic pulmonary TB: pulmonary lesions unaccompanied by hilar or mediastinal lymph node enlargement; 2) Tuberculous pneumonia: homogeneous consolidation with air bronchograms, with or without intrathoracic lymph node enlargement; 3) Hematogenous TB: diffuse pulmonar...

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“…The incidence of drug resistance among strains from the known HIV positive patients (6 of 122) was higher than in the other patients but, in view of the small numbers, this could well be due to chance. Multi-drug resistance is a serious problem among HIJV-positive tuberculosis patients in New York [9] but is not one that has yet been encountered in this region.…”

Section: Discussionmentioning

confidence: 99%

A bacteriological survey of tuberculosis due to the human tubercle bacillus (Mycobacterium tuberculosis) in South-East England: 1984–91

Yates

Grange

1993

Epidemiol. Infect.

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were known to be HIV positive. As in the 1977-83 study, disease in the ISC group affected younger patients than in the European group, tubercle bacilli were more frequently isolated from a non-pulmonary site in the ISC group (45 %) than in the European group (19%) and there was a higher incidence of the South Indian variant of M. tuberculosis in the former group ( 17 %) than in the latter (9 %). The overall incidence of drug resistance has not altered significantly since the 1977-83 study but 46 strains resistant to 3 or more drugs were isolated from 4099 ISC patients, compared with 3 of 4594 strains from European patients. Six of the 122 isolates from HIV positive patients were drug-resistant but none was multi-drug resistant.The slight rise in registered bacteriologically proven cases of tuberculosis, the presence of multi-drug resistant strains, the occurrence of HIV-related tuberculosis and reports of the emergence of multi-drug-resistant HIV-related tuberculosis in other countries strongly indicate the need for continued careful surveillance.

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HIV prevalence, immunosuppression, and drug resistance in patients with tuberculosis in an area endemic for AIDS

Cited by 99 publications

References 0 publications

Immunological responses of Gambians in relation to clinical stage of HIV-2 disease

Immunological responses of Gambians in relation to clinical stage of HIV-2 disease

Diferenças na apresentação clínico-radiológica da tuberculose intratorácica segundo a presença ou não de infecção por HIV

A bacteriological survey of tuberculosis due to the human tubercle bacillus (Mycobacterium tuberculosis) in South-East England: 1984–91

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