CD4 lymphocyte dynamics in Tanzanian pulmonary tuberculosis patients with and without HIV co-infection.

BACKGROUND: The interaction of HIV and tuberculosis (TB) on CD4 levels over time is complex and has been divergently reported. METHODS: CD4 counts were assessed from time of diagnosis till the end of TB treatment in a cohort of pulmonary TB patients with and without HIV co-infection and compared with cross-sectional data on age- and sex-matched non-TB controls from the same area. RESULTS: Of 1,605 study participants, 1,250 were PTB patients and 355 were non-TB controls. At baseline, HIV was associated with 246 (95% CI: 203; 279) cells per µL lower CD4 counts. All PTB patients had 100 cells per µL lower CD4 counts than the healthy controls. The CD4 levels were largely unchanged during a five-month of TB treatment. HIV infected patients not receiving ART at any time and those already on ART at baseline had no increase in CD4 counts after 5 months of TB treatment, whereas those prescribed ART between baseline and 2 months, and between 2 and 5 months increased by 69 (22;117) and 110 (52; 168) CD4 cells per µL after 5 months. CONCLUSIONS: The increase in circulating CD4 levels observed in PTB in patients is acquired after 2 months of treatment irrespective of HIV status. Initiation of ART is the strongest factor correlated with CD4 increase during TB treatment. TRIAL REGISTRATION NUMBER: Clinical trials.gov: NCT00311298.

Evaluation of the KEMRI Hep-cell II test kit for detection of hepatitis B surface antigens in Tanzania.

Hepatitis B surface antigen (HBsAg) is one of the most important serological markers used to diagnose acute and chronic hepatitis B infection. The objective of the current evaluation was to assess the operational characteristics of the Kenya Medical Research Institute (KEMRI) Hep-cell II against an ELISA Exsym HBsAg in the detection of hepatitis B surface antigens. To evaluate the Hep-cell II test, blood samples were collected from blood donors and processed for detection of HBsAg using Hep-cell II based on the test principle and procedure outlined by the manufacturer. ELISA Axsym HBsAg test was used as golden standard. Of the 400 samples tested, 287 (71.8%) were positive by Hep-cell test and 295 (73.8%) were positive by the ELISAAxsym. Hep-cell test had a sensitivity of 98.6% and specificity of 95.96%. Similar values of sensitivity and specificity of the Hep-cell test were obtained even when Bayesian Analysis Model was applied. The positive and negative predictive values of Hep-cell test were 98.61% and 95.96%, respectively. The positive and negative diagnostic likelihood ratios of Hep-cell test were 24.4% and 0.0145, respectively. In conclusion, the Hep-cell test is useful for detecting hepatitis B virus and the high likelihood ratio observed suggests that it may be useful in blood screening. However, it may be necessary to evaluate for cost-effectiveness and robustness in field conditions before the test is recommended for use.

The role of micronutrients and co infection in pulmonary tuberculosis. a randomized controlled trial in mwanza, tanzania / The role of micronutrients and co infection in pulmonary tuberculosis. a randomized controlled trial in Mwanza, Tanzania

Tuberculosis (TB) is one of the World s major public health problems with one third of the world's population being infected, and each year eight million new cases of TB develop with three million new cases 80% occur in sub-Saharan Africa with 30-70% of the TB patients being HIV infected .HIV is recognized as the most important risk factor TB reactivation and the increased TB incident .Tanzania is among the 22 high TB burden countries in the world with 20-70% of TB cases being co-infected with HIV, TB is the third cause of deaths in the country after malaria and HIV/ AIDS among adults. In addition to a high prevalence of HIV infection, parasitic co-infections and micronutrient deficiency are also prevalence and may together contribute to the fast progressions of the disease and high mortality. Despite the fact that anti-TB drugs are still affective in curing TB, a long period of treatment is required.