Johns Hopkins University Department of Biomedical Engineering, 3510 N Charles Street, Baltimore, MD, 21218, USA.
School of Nursing at MGH Institute of Health Professions, 36 1st Ave, Charlestown, MA, 02129, USA.
BMC Infect Dis. 2020 Oct 15;20(1):756. doi: 10.1186/s12879-020-05458-w.
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.
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.
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.
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.
感染人类免疫缺陷病毒（HIV）会大大增加发生活动性结核病（TB）的风险。多项研究表明，TB 合并感染会增加 HIV 进展和死亡的风险。撒哈拉以南非洲首当其冲地受到这两种传染病的影响，约有 240 万 HIV 感染者同时患有 TB。我们研究的主要目的是评估在接受抗逆转录病毒治疗（HAART）之前的 CD4+T 淋巴细胞计数和百分比是否可以作为 HIV 阳性儿童合并或不合并 TB 感染后免疫恢复的标志物。
本回顾性研究分析的数据来自正在接受 HAART 治疗的 305 名 HIV 感染儿童的队列。使用 Lehmann 家族 ROC 曲线来评估在接受 HAART 治疗之前的 CD4+T 淋巴细胞计数和百分比作为免疫恢复的标志物的诊断性能。使用 Kaplan-Meier 估计器来比较合并或不合并 TB 感染的患者之间在接受 HAART 后免疫恢复时间的差异。
我们发现，在接受 HAART 治疗之前的 CD4+T 淋巴细胞计数和百分比的诊断性能相当，准确率高达 74%。此外，在 TB 阴性患者中，预测前 HAART CD4+T 淋巴细胞计数和百分比的能力稍好。我们的分析还表明，TB 阴性患者的恢复时间比 TB 阳性患者短。
在 TB 阴性儿科患者中，HAART 之前的 CD4+T 淋巴细胞计数和百分比是免疫恢复的更强预测指标，这表明 TB 合并感染使该队列中 HIV 的治疗复杂化。这些发现表明，在 HIV 感染的儿科患者中，检测和治疗 TB 对于 HAART 的有效性至关重要。
