3rd International AIDS Society Conference on HIV Pathogenesis and Treatment


Rio de Janeiro - July 24 - 27, 2005

IMMUNOLOGICAL STATUS AND PROGNOSIS OF HIV-INFECTED PATIENTS WITH ACTIVE TUBERCULOSIS

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. WePp0306

Scano F.1, Toskin I.1, Nunn P.1
1World Health Organization, Geneva, Switzerland

INTRODUCTION: To assess prognosis and immunological status of HIV+ patients with TB in various resource-limited settings.

METHODS: Immunological and survival data for patients with HIV-related TB were reviewed up to May 2005.

RESULTS: Although there is considerable variation in the observed CD4 cell counts in HIV+ people with tuberculosis, the average mean value of 13 studies is 175.7 cells/µL [CI 95%; 168,7:182,7]. For pulmonary TB, the average CD4 count is 215.9 [95%CI; 187,9:243,9] cells/µL, while for extra pulmonary TB and for studies that do not differentiate between TB diagnoses (referred to as all forms) is 143.3 [95%CI; 124,6 : 162], and 131.1 [95%CI; 113,5 : 148,7] cells/µL, respectively. The difference in average median CD4 counts is statistically significant between studies reporting on all forms of TB (p<0.051) and pulmonary TB. For resource-limited settings other than Africa, the average CD4 count at which TB is detected is 125 cells/µL . This is statistically significant (p=0.027) when compared to average CD4 counts in Africa (200 cells/µL). Studies conducted before 1995 show a significantly higher average CD4 count (p=0.0114) than those dated thereafter. The median survival rate for HIV-infected tuberculosis patients is 18.5 months.

CONCLUSIONS: One decade ago it was thought that tuberculosis occurred across a wide range of CD4 cell counts (Lancet. 1993 Jul 17;342(8864):143-6 and Lancet. 1995 Mar 11;345(8950):607-10); however, our results, based on prognostic significance and CD4 counts, show that all TB, irrespective of diagnoses, should be considered as advanced/late HIV-opportunistic infection. We hypothesize that maturing of the HIV epidemic results in a stronger epidemiological and immunological link between TB and HIV, explaining the difference between observations made ten years ago and data collected more recently. This is also supported by modelling studies that indicate that there is a temporal gap of 6 years between the surging of the HIV epidemic and its impact on the TB burden.

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