OBJECTIVES: The study aimed to determine the clinical and laboratory predictors of a low CD4+ cell count (<200 cells/microl) in HIV-infected patients with pulmonary tuberculosis (PTB). DESIGN AND SETTING: A prospective cohort study on HIV-positive patients with smear-positive PTB attending an outpatient clinic in Zimbabwe. PARTICIPANTS: Consecutively consenting HIV-positive adults, aged 18 years and over, who had positive sputum smears for acid-fast bacilli and were naïve to both antituberculosis drugs and ART. INTERVENTIONS: Baseline CD4+ cell count, full blood count, functional status using the Karnofsky Performance Status (KPS) score and body mass index (BMI, kg/m2) were determined for all participants. Univariate and multiple logistic regression analyses of the data were done. RESULTS: Of the 97 participants recruited, 59 (61%) were females. The overall mean age was 34 years (standard deviation (SD) 8). The median CD4+ cell count was 104.5 cells/microl (intraquartile range (IQR) 41-213 cells/microl). Patients with pleuritic chest pain were less likely to have a low CD4+ cell count than patients who did not (odds ratio (OR) 0.2; confidence interval (CI) 0.03-0.8). The following were statistically significant predictors of a CD4+ cell count of <200 cells /microl: BMI<18 kg/m2 (OR 3.8; CI 1.2-12), KPS<54.4 (OR 3; CI 1.1-12) and haemoglobin concentration<8 g/dl (OR 13; CI 1.8 - 533). CONCLUSIONS: HIV-infected sputum-positive PTB patients presenting with a BMI<18, KPS<54.4% and haemoglobin concentration<8 g/dl should have early initiation of ART since they are more likely to have a low CD4+ cell count, whereas those presenting with pleuritic pain are less likely to have a low CD4+ cell count.
OBJECTIVES: The study aimed to determine the clinical and laboratory predictors of a low CD4+ cell count (<200 cells/microl) in HIV-infectedpatients with pulmonary tuberculosis (PTB). DESIGN AND SETTING: A prospective cohort study on HIV-positive patients with smear-positive PTB attending an outpatient clinic in Zimbabwe. PARTICIPANTS: Consecutively consenting HIV-positive adults, aged 18 years and over, who had positive sputum smears for acid-fast bacilli and were naïve to both antituberculosis drugs and ART. INTERVENTIONS: Baseline CD4+ cell count, full blood count, functional status using the Karnofsky Performance Status (KPS) score and body mass index (BMI, kg/m2) were determined for all participants. Univariate and multiple logistic regression analyses of the data were done. RESULTS: Of the 97 participants recruited, 59 (61%) were females. The overall mean age was 34 years (standard deviation (SD) 8). The median CD4+ cell count was 104.5 cells/microl (intraquartile range (IQR) 41-213 cells/microl). Patients with pleuritic chest pain were less likely to have a low CD4+ cell count than patients who did not (odds ratio (OR) 0.2; confidence interval (CI) 0.03-0.8). The following were statistically significant predictors of a CD4+ cell count of <200 cells /microl: BMI<18 kg/m2 (OR 3.8; CI 1.2-12), KPS<54.4 (OR 3; CI 1.1-12) and haemoglobin concentration<8 g/dl (OR 13; CI 1.8 - 533). CONCLUSIONS:HIV-infected sputum-positive PTB patients presenting with a BMI<18, KPS<54.4% and haemoglobin concentration<8 g/dl should have early initiation of ART since they are more likely to have a low CD4+ cell count, whereas those presenting with pleuritic pain are less likely to have a low CD4+ cell count.
Authors: Sten Skogmar; Taye T Balcha; Zelalem H Jemal; Jonas Björk; Wakgari Deressa; Thomas Schön; Per Björkman Journal: Glob Health Action Date: 2014-02-13 Impact factor: 2.640
Authors: David G Dillon; Deepti Gurdasani; Johanna Riha; Kenneth Ekoru; Gershim Asiki; Billy N Mayanja; Naomi S Levitt; Nigel J Crowther; Moffat Nyirenda; Marina Njelekela; Kaushik Ramaiya; Ousman Nyan; Olanisun O Adewole; Kathryn Anastos; Livio Azzoni; W Henry Boom; Caterina Compostella; Joel A Dave; Halima Dawood; Christian Erikstrup; Carla M Fourie; Henrik Friis; Annamarie Kruger; John A Idoko; Chris T Longenecker; Suzanne Mbondi; Japheth E Mukaya; Eugene Mutimura; Chiratidzo E Ndhlovu; George Praygod; Eric W Pefura Yone; Mar Pujades-Rodriguez; Nyagosya Range; Mahmoud U Sani; Aletta E Schutte; Karen Sliwa; Phyllis C Tien; Este H Vorster; Corinna Walsh; Rutendo Zinyama; Fredirick Mashili; Eugene Sobngwi; Clement Adebamowo; Anatoli Kamali; Janet Seeley; Elizabeth H Young; Liam Smeeth; Ayesha A Motala; Pontiano Kaleebu; Manjinder S Sandhu Journal: Int J Epidemiol Date: 2013-12 Impact factor: 7.196