AEGiS-13IAC: Changes in HIV-1 RNA viral load, CD4+ T-cell counts and levels of immune activation markers associated with tuberculosis therapy in HIV-infected TB patients in Abidjan, Cote d'Ivoire.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Changes in HIV-1 RNA viral load, CD4+ T-cell counts and levels of immune activation markers associated with tuberculosis therapy in HIV-infected TB patients in Abidjan, Cote d'Ivoire.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrC186)

Kalou-Badirou M, Nkengasong J, Sassan - Morokro M, Bile C, Abouya L, Ackah A, Maurice C, Coulibaly D, Roels TH, Greenberg AE, Wiktor SZ
M. Kalou-Badirou, Projet Retro - CI, 01 BP 1712, Abidjan 01, Cote D'ivoire, Tel.: +225 2 125 4111, Fax: +225 2 124 2969, E-mail: cfk3@cdc.gov

OBJECTIVES: To compare plasma HIV-1 RNA viral load (VL), CD4+ T-cell counts and immune activation markers in HIV-infected tuberculosis (TB) patients at the start of and 11 months after initiation of TB treatment.

METHODS: Plasma specimens obtained at the start of and 11 months after the initiation of TB treatment were selected from 66 HIV-1-infected patients with newly diagnosed, sputum-culture confirmed (Bactec media) M. tuberculosis pulmonary infection. Viral load (VL) was quantified by the Amplicor Monitor assay (v 1.5, Roche Diagnostics), CD4 lymphocytes were enumerated by standard flow cytometry, and immune activation markers [neopterin, b 2 -microglobulin, and soluble tumor necrosis factor II (sTNFa RII)] were measured by commercially available assays. Syncytium induction (SI) was determined by the MT-2 assay. All patients received a standard short-course regimen of 6 months of rifampin and isoniazid with 2 months of pyrazinamid.

RESULTS: The median [interquartile range (IQR)] age of the 66 patients (27 female and 39 males) was 34 years (29-50). All patients had negative sputum-culture at >9 months of follow-up. Median (IQR) VL (log₁₀ copies/mL) increased significantly from 4.3 (3.6-4.7) at start of TB therapy to 5.1 (4.4-5.5) after 11 months (p > 0.001). Median (IQR) CD4+ count/m L was 364 (202-526) at start of therapy and 325 (174-464) at 11 months (p = 0.13). Activation markers decreased significantly from onset of therapy and at 11 months: Neopterin (ng/mL) 12 (7.9-18.5) vs. 8.5 (5-16) (p = 0.01); sTNFa RII (pg/mL) 5.0 (3.5-6.4) vs. 3.0 (2.0-4.1) (p = 0.0003); and b 2-microglobulin (ng/mL), 4.5 (3.5-5.7) vs 3.5 (2.5-4.7) (p = 0.0001). The increase in VL was not explained by the presence of SI phenotypes, since at 11 months, only 3 (5%) of the 60 patients analyzed were MT-2 positive.

CONCLUSIONS: Among HIV-1 infected TB patients, plasma VL increased significantly between onset of TB therapy and 11 months of follow-up despite successful response to TB treatment. However, immune activation markers decreased significantly during this time period. The increase in VL may help explain the high mortality observed among HIV-infected TB patients.

Keywords: AEGIS, CD4 Lymphocyte Count, Viral Load, HIV, HIV Infections, Tuberculosis, HIV Seropositivity, HIV-1, Biological Markers, Anti-HIV Agents, CD4-Positive T-Lymphocytes, Antiretroviral Therapy, Highly Active, Receptors, HIV, Neopterin, HIV Seronegativity, Cote d'Ivoire, Human, Male, Female, therapy, immunology, drug therapy
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MoOrC186