ABSTRACT
OBJECTIVES: To describe HIV RNA levels during tuberculosis (TB) infection in patients co-infected with TB and HIV. Moreover, to examine the p24 antigen profile during TB treatment. METHODS: We examined the changes in CD4 cell count, HIV RNA, and p24 levels during anti-tuberculous therapy in a group of TB/HIV-1 co-infected and HIV-untreated patients from Guinea-Bissau. RESULTS: A total of 365 TB patients were enrolled, of whom 76 were co-infected with HIV-1 and 19 were dually infected with HIV-1 + HIV-2. No significant changes in CD4, HIV RNA, or p24 levels were found during 8 months of TB treatment. HIV RNA levels correlated well with p24 (Spearman's R(2)=0.52, p<0.00001) and both markers were strong predictors of mortality. Initial HIV RNA levels correlated with a clinical TB severity index--the TBscore (Spearman's R(2)=0.23, p=0.02)--and the TBscore decreased dramatically during TB treatment although HIV RNA levels remained unchanged. CONCLUSION: We found no significant changes in CD4, HIV RNA, or p24 antigen levels during 8 months of TB treatment among TB/HIV co-infected individuals, who did not receive antiretroviral treatment. The markers were unaffected by a strong improvement in TBscore and all three markers showed predictive capacity for mortality risk.
Subject(s)
Antitubercular Agents/pharmacology , Coinfection/immunology , HIV Infections/immunology , HIV-1/immunology , HIV-2/immunology , Tuberculosis, Pulmonary/drug therapy , Adult , Antitubercular Agents/therapeutic use , Biomarkers/blood , CD4 Lymphocyte Count , Coinfection/blood , Coinfection/mortality , Dietary Supplements , Drug Therapy, Combination , Ethambutol/pharmacology , Ethambutol/therapeutic use , Female , Guinea-Bissau , HIV Core Protein p24/blood , HIV Infections/blood , HIV Infections/mortality , Humans , Isoniazid/pharmacology , Isoniazid/therapeutic use , Kaplan-Meier Estimate , Male , Middle Aged , Pyrazinamide/pharmacology , Pyrazinamide/therapeutic use , RNA, Viral , Rifampin/pharmacology , Rifampin/therapeutic use , Tuberculosis, Pulmonary/blood , Tuberculosis, Pulmonary/immunology , Tuberculosis, Pulmonary/mortality , Vitamin D/administration & dosage , Young AdultABSTRACT
SETTING: Jizan region, Saudi Arabia. OBJECTIVE: To test methodology for studies of tuberculin sensitivity and effectiveness of BCG vaccination programme. DESIGN: School children (n = 315) aged 6-12 years simultaneously tested intradermally with PPD tuberculin RT23, 2TU and 0.1 microgram Mycobacterium avium or M. scrofulaceum sensitin. Presence of BCG scar as evidence of previous BCG vaccination. Cervical lymph nodes palpated. RESULTS: BCG coverage was 75%. The prevalences of positive reactions (induration > or = 6 mm) were higher among children with than without scar. Prevalences of positive reactions to PPD and M. scrofulaceum sensitin were higher among girls than boys. In children with scar, the mean size of positive reactions to PPD was larger among girls than boys, and the prevalence of positive reactions was smaller in this group among children with than without palpable cervical lymph nodes. The sizes of reactions both to M. avium and to M. scrofulaceum sensitin were correlated to the size of the tuberculin reactions. Previous admission to hospital was reported less often by children with than without scar. CONCLUSIONS: The technique applied and training of staff was satisfactory. In further studies, however, we will apply three simultaneous tests to each person.
