<p>Prevalence and Predictors of CD4+ T-Lymphocytopenia Among HIV-Negative Tuberculosis Patients in Uganda</p>

Abstract

Purpose: CD4+ T-lymphocytopenia is a risk for tuberculosis (TB) infection, reactivation and severe disease. We sought to determine the prevalence and predictors of CD4 T-lymphocytopenia among HIV-negative patients with bacteriologically confirmed TB in Uganda. Patients and Methods: Eligible participants were adult HIV-negative patients with bacteriologically confirmed TB at the National TB Treatment Centre in Uganda. CD4+ and CD8+ T-lymphocyte counts were determined by flow cytometry. We defined CD4+ T-lymphocytopenia as a CD4+ T-lymphocyte count of <418 cells/mm 3 as per the population estimate for Ugandans. We performed logistic regression analysis to determine predictors of CD4+ T-lymphocytopenia. Results: We enrolled 216 participants whose mean age (standard deviation (±SD)) was 32.5 (±12.1) years, of whom 146 (67.6%) were males. The prevalence of CD4+ T-lymphocytopenia was 25% (54/216) (95% confidence interval (CI): 19.6-31.2%). Patients with anaemia (adjusted odds ratio (aOR): 3.83, 95% CI: 1.59-9.23, p = 0.003), weight loss (aOR: 3.61, 95% CI: 1.07-12.23, p = 0.039) and a low CD8+ T-cell count (aOR: 6.10, 95% CI: 2.68-13.89, p < 0.001) were more likely to have CD4+ T-lymphocytopenia while those with monocytosis (aOR: 0.35, 95% CI: 0.14-0.89, p = 0.028) were less likely to have CD4+ T-lymphocytopenia. Conclusion: There was a high prevalence of CD4+ T-lymphocytopenia among HIVnegative TB patients. Patients with weight loss, anaemia and a low CD8+ count were more likely to have CD4+ T-lymphocytopenia while those with monocytosis were less likely to have CD4+ lymphocytopenia. The findings suggest that CD4+ lymphocytopenia is indicative of severe disease and globally impaired cell-mediated immune responses against TB.

Gender differences among patients with drug resistant tuberculosis and HIV co-infection in Uganda: a countrywide retrospective cohort study

“…CD4 T-lymphocytes produce interferon-gamma which is important in immune responses against TB [ 53 ]. Low CD4 counts are therefore associated with globally impaired TB immune responses and severe TB disease [ 54 ]. It should be expected that ART default will be associated with a failure to reconstitute the immune system.…”

Undernutrition and Treatment Success in Drug-Resistant Tuberculosis in Uganda

“…43,44 Anaemia is associated with low CD4+ T-lymphocyte counts, delayed sputum culture conversion, and severe forms of TB. [45][46][47] Therefore, smoking, anaemia and undernutrition can be expected to synergistically increase the risk of unfavourable TB outcomes. While the optimal management of anaemia in DRTB is not known, barriers to integrating smoking cessation programs in DRTB care should be addressed.…”

Prevalence of anaemia and associated factors among people with pulmonary tuberculosis in Uganda

“…Additionally, TB was the commonest diagnosis (diagnosed among 22%) in people with anaemia at the emergency unit of a national referral hospital [11]. We have recently shown that HIV-negative TB patients with anaemia were more likely to have low CD4 T-lymphocytes at the NTTC [12].…”

“…Additionally, TB was the commonest diagnosis (diagnosed among 22%) in people with anaemia at the emergency unit of a national referral hospital [ 11 ]. We have recently shown that HIV-negative TB patients with anaemia were more likely to have low CD4 T-lymphocytes at the NTTC [ 12 ]. These studies suggest that the prevalence of anaemia among TB patients in Uganda may be high and could be associated with impaired immune responses and severe TB disease.…”