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. 2020 Oct 15;20(1):756.
doi: 10.1186/s12879-020-05458-w.

Pre-HAART CD4+ T-lymphocytes as biomarkers of post-HAART immune recovery in HIV-infected children with or without TB co-infection

Vivek Gopalakrishnan  1 , Eliezer Bose  2 , Usha Nair  3 , Yuwei Cheng  4 , Musie Ghebremichael  5   6
Affiliations

Pre-HAART CD4+ T-lymphocytes as biomarkers of post-HAART immune recovery in HIV-infected children with or without TB co-infection

Vivek Gopalakrishnan et al. BMC Infect Dis. .

Abstract

Background: Infection with the Human Immunodeficiency Virus (HIV) dramatically increases the risk of developing active tuberculosis (TB). Several studies have indicated that co-infection with TB increases the risk of HIV progression and death. Sub-Saharan Africa bears the brunt of these dual epidemics, with about 2.4 million HIV-infected people living with TB. The main objective of our study was to assess whether the pre-HAART CD4+ T-lymphocyte counts and percentages could serve as biomarkers for post-HAART treatment immune-recovery in HIV-positive children with and without TB co-infection.

Methods: The data analyzed in this retrospective study were collected from a cohort of 305 HIV-infected children being treated with HAART. A Lehmann family of ROC curves were used to assess the diagnostic performance of pre- HAART treatment CD4+ T-lymphocyte count and percentage as biomarkers for post-HAART immune recovery. The Kaplan-Meier estimator was used to compare differences in post-HAART recovery times between patients with and without TB co-infection.

Results: We found that the diagnostic performance of both pre-HARRT treatment CD4+ T-lymphocyte count and percentage was comparable and achieved accuracies as high as 74%. Furthermore, the predictive capability of pre-HAART CD4+ T-lymphocyte count and percentage were slightly better in TB-negative patients. Our analyses also indicate that TB-negative patients have a shorter recovery time compared to the TB-positive patients.

Conclusions: Pre-HAART CD4+ T-lymphocyte count and percentage are stronger predictors of immune recovery in TB-negative pediatric patients, suggesting that TB co-infection complicates the treatment of HIV in this cohort. These findings suggest that the detection and treatment of TB is essential for the effectiveness of HAART in HIV-infected pediatric patients.

Keywords: CD4+ T-lymphocytes; immune recovery; HAART; HIV; ROC curves; TB.

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Conflict of interest statement

Musie Ghebremichael is an editorial board member of BMC Infectious Diseases journal. Other authors do not have a commercial or other association that might pose a conflict of interest, i.e., authors declare that they have no competing interests to disclose.

Figures

Fig. 1
Fig. 1
Kaplan-Meier estimates of time until immune recovery for HIV-infected patients with and without TB co-infection
Fig. 2
Fig. 2
Distribution of pre-HAART CD4+ T-lymphocyte counts and percentages by post-HAART immune recovery status. The lower and upper panels of the figure are for patients who achieved and failed to achieve post-HAART immune recovery, respectively
Fig. 3
Fig. 3
ROC curves for pre-HAART CD4+ T-lymphocyte counts and percentages
Fig. 4
Fig. 4
ROC curves for pre-HAART CD4+ T-lymphocyte counts and percentages by TB status. The left and right panels of the figure are for TB-negative and TB-positive patients, respectively
See this image and copyright information in PMC

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