Tuberculosis Research Unit, Case Western Reserve University School of Medicine, and University Hospitals-Case Medical Center, Cleveland, Ohio, United States of America.
PLoS One. 2010 Feb 22;5(2):e9138. doi: 10.1371/journal.pone.0009138.
Both HIV and TB cause a state of heightened immune activation. Immune activation in HIV is associated with progression to AIDS. Prior studies, focusing on persons with advanced HIV, have shown no decline in markers of cellular activation in response to TB therapy alone.
This prospective cohort study, composed of participants within a larger phase 3 open-label randomized controlled clinical trial, measured the impact of TB treatment on immune activation in persons with non-advanced HIV infection (CD4>350 cells/mm3) and pulmonary TB. HIV load, CD4 count, and markers of immune activation (CD38 and HLA-DR on CD4 and CD8 T cells) were measured prior to starting, during, and for 6 months after completion of standard 6 month anti-tuberculosis (TB) therapy in 38 HIV infected Ugandans with smear and culture confirmed pulmonary TB.
Expression of CD38, and co-expression of CD38 and HLA-DR, on CD8 cells declined significantly within 3 months of starting standard TB therapy in the absence of anti-retroviral therapy, and remained suppressed for 6 months after completion of therapy. In contrast, HIV load and CD4 count remained unchanged throughout the study period.
TB therapy leads to measurable decreases in immune activation in persons with HIV/TB co-infection and CD4 counts>350 cells/mm3.
HIV 和结核病都导致免疫激活状态升高。HIV 中的免疫激活与艾滋病的进展有关。先前的研究集中在晚期 HIV 患者身上，表明单独接受结核病治疗并不会导致细胞激活标志物下降。
这项前瞻性队列研究由一项更大的 3 期开放性标签随机对照临床试验中的参与者组成，旨在测量结核病治疗对非晚期 HIV 感染（CD4>350 个细胞/mm3）和肺结核患者免疫激活的影响。在开始治疗前、治疗期间和完成标准 6 个月抗结核（TB）治疗后 6 个月，对 38 名 HIV 感染者进行了 HIV 载量、CD4 计数和免疫激活标志物（CD4 和 CD8 T 细胞上的 CD38 和 HLA-DR）的测量，这些患者均经涂片和培养证实患有肺结核。
在未接受抗逆转录病毒治疗的情况下，开始标准 TB 治疗后 3 个月内，CD8 细胞上的 CD38 表达以及 CD38 和 HLA-DR 的共表达显著下降，并在治疗结束后 6 个月内仍受到抑制。相比之下，HIV 载量和 CD4 计数在整个研究期间保持不变。
在 HIV/TB 合并感染且 CD4 计数>350 个细胞/mm3 的患者中，结核病治疗可导致免疫激活的可测量下降。
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