Aspects of Tuberculosis and HIV Coinfection in Patients at Ethiopian Health Centers
Author
Summary, in English
In a second part of the thesis, we evaluated the impact of TB on the immune system, both on peripheral CD4 cells and neopterin as a marker of immune activation. In paper III, we found that 25% of HIV negative patients with TB had low CD4 cell count (below 500 cells/mm3). These levels increased until end of TB treatment but not to levels found in healthy controls, suggesting a sustained impact of TB on CD4 cell homeostasis. CD4 cell levels were associated with signs of severe TB (positive sputum smear microscopy, low mid upper arm circumference and bedridden status). In paper IV, neopterin levels were increased in TB patients (23.2 nmol/l) compared to controls (3.8nmol/l), particularly in HIV/TB coinfected patients (54nmol/l). Neopterin correlated to low CD4 cell count, and high neopterin levels were associated with increasing CD4 cell levels during treatment for TB. Yet, neopterin was not suitable as surrogate markers for CD4 cell count. In conclusion, this thesis shows that clinical evaluation of patients should be an integral part in the building of health care for HIV and TB in low-income settings, and that clinically based instruments may be helpful for triage and clinical decisions. Furthermore, we found that TB has an impact on both CD4 cell levels and immune activation. This further emphasizes the need to detect and treat TB in PLHIV.
Department/s
- Infectious Diseases Research Unit
Publishing year
2015
Language
English
Publication/Series
Lund University Faculty of Medicine Doctoral Dissertation Series
Volume
2015:57
Full text
Document type
Dissertation
Publisher
Infectious Diseases
Topic
- Infectious Medicine
Keywords
- HIV
- TB
- clinical scoring
- TB screening
- CD4 cell count
- immunosuppression
- immune activation
Status
Published
Research group
- Infectious Diseases Research Unit
Supervisor
- Per Björkman
- Tomas Schönthal
ISBN/ISSN/Other
- ISSN: 1652-8220
- ISBN: 978-91-7619-136-1
Defence date
1 June 2015
Defence time
13:00
Defence place
Patologens föreläsningssal, Jan Waldenströms gata 61, Malmö
Opponent
- Alison Grant