Immunological non-response and low hemoglobin levels are predictors of incident tuberculosis among HIV-infected individuals on Truvada-based therapy in Botswana

Abstract

BackgroundThere is a high burden of tuberculosis (TB) in HIV antiretroviral programmes in Africa. However, few studies have looked at predictors of incident TB while on Truvada-based combination antiretroviral therapy (cART) regimens.MethodsWe estimated TB incidence among individuals enrolled into an observational cohort evaluating the efficacy and tolerability of Truvada-based cART in Gaborone, Botswana between 2008 and 2011. We used Cox proportional hazards regressions to determine predictors of incident TB.ResultsOf 300 participants enrolled, 45 (15%) had a diagnosis of TB at baseline. During 428 person-years (py) of follow-up, the incidence rate of TB was 3.04/100py (95% CI, 1.69–5.06), with 60% of the cases occurring within 3 months of ART initiation. Incident cases had low baseline CD4+ T cell counts (153cells/mm3 [Q1, Q3: 82, 242]; p = 0.69) and hemoglobin levels (9.2g/dl [Q1, Q3: 8.5,10.1]; p<0.01). In univariate analysis, low BMI (HR = 0.73; 95% CI 0.58–0.91; p = 0.01) and hemoglobin levels <8 g/dl (HR = 10.84; 95%CI: 2.99–40.06; p<0.01) were risk factors for TB. Time to incident TB diagnosis was significantly reduced in patients with poor immunological recovery (p = 0.04). There was no association between baseline viral load and risk of TB (HR = 1.75; 95%CI: 0.70–4.37).ConclusionLow hemoglobin levels prior to initiation of ART are significant predictors of incident tuberculosis. Therefore, there is potential utility of iron biomarkers to identify patients at risk of TB prior to initiation on ART. Furthermore, additional strategies are required for patients with poor immunological recovery to reduce excess risk of TB while on ART.

Pulmonary tuberculosis screening in anti-retroviral treated adults living with HIV in Kenya

“…(Table 2) ESR and CRP had the largest areas under the ROC curve. In our study, the use of published cutoffs for CRP at 5 mg/L [30], 8 mg/L [29], and 10 mg/L [28]; hemoglobin at 8 g/dL [31]; and MLR at 0.285 [33]; were associated with poor sensitivity and PPV. In terms of optimizing sensitivity and specificity, the biomarker and cut-point that was closest to the WHO target product profile [12] was CRP > 3.3 mg/L: sensitivity 80% (95% CI, 28-100), specificity 72% (95% CI, 67-77).…”

“…We evaluated additional candidate biomarkers for TB disease. Various cut-points for the biomarkers were obtained from published studies, including CRP [28][29][30], hemoglobin [31,32], and monocyte-to-lymphocyte ratio [33], and/or derived from the current study based on Youden's index. (Table 2) ESR and CRP had the largest areas under the ROC curve.…”

Role of CD4/CD8 ratio on the incidence of tuberculosis in HIV-infected patients on antiretroviral therapy followed up for more than a decade

“…Nonetheless, limitations related to our study include that our findings cannot be generalized to the entire population as the data is generated from the private sector and included only one study site. The diagnosis of TB in SSA setting is challenging as it is not definitive being without microbiological confirmation for all patients [14,15,21,47,49,50], as is for our cohort. All our patients received IPT for preventing TB as of 2010.…”

Effect of Dietary Modification on Gastric Mucosa, Gastrointestinal Symptoms and Nutritional Status of Patients With Early Gastric Cancer After Endoscopic Submucosal Dissection Surgery: A Retrospective Cohort Study

“…Low Hb (anemia) is a common nutritional problem in EGC ( 42 ). Protein malnutrition can inhibit the proliferation and differentiation of hematopoietic stem cells ( 43 ), inhibit immune responses, and cause chronic inflammation, leading to changes in iron metabolism ( 44 ) that result in decreased hemoglobin. These indicators can be used to evaluate the nutritional status of patients ( 45 ).…”