Age, sex, and nutritional status modify the CD4+ T-cell recovery rate in HIV–tuberculosis co-infected patients on combination antiretroviral therapy
Loading...
Date
2015-03
Authors
Ezeamama, Amara E.
Mupere, Ezekiel
Oloya, James
Martinez, Leonardo
Kakaire, Robert
Yin, Xiaoping
Sekandi, Juliet N.
Whalen, Christopher C.
Journal Title
Journal ISSN
Volume Title
Publisher
International Journal of Infectious Diseases
Abstract
Background
We examined baseline age and combination antiretroviral therapy (cART) as determinants of CD4+T-cell recovery during six months of tuberculosis (TB) therapy with/without cART. We determined whether this association was modified by patient sex and nutritional status.
Methods
This longitudinal analysis included 208 immune-competent, non-pregnant, ART-naive HIV-positive patients from Uganda with a first episode of pulmonary TB. CD4+T-cell count was measured using flow cytometry. Age was defined as ≤24, 25–29, 30–34, 35–39 vs. ≥ 40 years. Nutritional status was defined as normal (>18.5kg/m2) vs. underweight (≤18.5kg/m2) using body mass index (BMI). Multivariate random-effects linear mixed models were fitted to estimate differences in CD4+T-cell recovery in relation to specified determinants.
Results
cART was associated with a monthly rise of 15.7 cells/μL (p<0.001). Overall, age was not associated with CD4+T-cell recovery during TB therapy (p=0.655). However, among patients on cART, age-associated CD4+T-cell recovery rate varied by sex and nutritional status such that age <40 vs. ≥ 40 years predicted superior absolute CD4+T-cell recovery among females (p=0.006) and among patients with BMI≥18.5kg/m2 (p<0.001).
Conclusions
TB infected HIV-positive patients ≥ 40 years have a slower rate of immune restoration given cART-particularly if BMI>18.5kg/m2 or female. They may benefit from increased monitoring and nutritional support during cART.
Description
The study examined baseline age and combination antiretroviral therapy (cART) as determinants of CD4+T-cell recovery during six months of tuberculosis (TB) therapy with/without cART. We determined whether this association was modified by patient sex and nutritional status.
Keywords
HIV , Nutritional status , Immune-competence , Aging , HAART
Citation
Ezeamama, Amara E., Mupere, Ezekiel, Oloya, James, Martinez, Leonardo, Kakaire, Robert, Yin, Xiaoping, Sekandi, Juliet N., Whalen, Christopher C., 2015. Age, sex, and nutritional status modify the CD4+ T-cell recovery rate in HIV–tuberculosis co-infected patients on combination antiretroviral therapy, International Journal of Infectious Diseases, 35:73-9. doi: 10.1016/j.ijid.2015.04.008.