Diagnosis of pulmonary tuberculosis among asymptomatic HIV+ patients in Guangxi, China

Background Pulmonary tuberculosis (PTB) among asymptomatic Chinese patients with HIV infection has not been investigated despite high tuberculosis burden in China. This study was aimed to evaluate the prevalence, risk factors and clinical outcomes of PTB among asymptomatic patients with HIV/AIDS in Guangxi to facilitate the development of diagnostic and treatment strategies.Methods All asymptomatic adult HIV-infected patients with CD4 ＜350 cells/μl who attended four HIV clinics in Guangxi between August 2006 and March 2008 were evaluated for active PTB with physical examination, chest X-ray (CXR),sputum smear and/or sputum liquid culture. Data were described using median (interquartile range, IQR) and frequencies.Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with PTB.Results Among 340 asymptomatic subjects, 15 (4%) were diagnosed with PTB, with 4 (27%) sputum smear positive and 8 (53%) sputum culture positive. CXR has higher diagnostic sensitivity (87%) than sputum smear (25%) and sputum culture (67%), but lower specificity (56%) compared with sputum smear (99%) and culture (100%). In univariate analysis,injection drug user, body mass index (BMI) ＜18 kg/m2, CD4 ＜50 cells/μl and presence of peripheral lymphadenopathy were associated with an increased risk of asymptomatic PTB, while in multivariate analysis only peripheral lymphadenopathy maintained statistical significance (OR=7.6, 95% CI 1.4-40). Patients with negative smear and minor or no abnormalities on CXR had longer interval between screening and TB treatment.Conclusions PTB was relatively common in this group of HIV+ asymptomatic Chinese patients. Diagnosis is challenging especially where sputum culture is unavailable. These findings suggest that an enhanced evaluation for PTB needs to be integrated with HIV care in China and transmission prevention in China to control at both households and health care facilities, especially for patients with factors associated with a higher risk of PTB.     

艾滋病合并结核病近期临床疗效观察

目的 探讨艾滋病合并结核病的诊断及治疗的近期疗效。方法 对河南省某局部地区98例艾滋病合并结核病患者的临床资料进行分析。结果 98例艾滋病合并结核病患者以发热、咳嗽、盗汗、体质量降低、浅表淋巴结肿大、呼吸困难为常见症状。采用鸡尾酒疗法抗病毒治疗以及6个月短程方案2SHRZ/4HRZ抗结核治疗[S(链霉素) 、H(异烟肼)、R( 利福平) 、Z( 吡嗪酰胺)],病人临床症状、体征、病灶吸收率、空洞好转率、免疫功能均有改善。结论 结核科医师应加强对HIV合并结核诊断的认识。痰涂片检查抗酸杆菌及X线检查仍具有较好的诊断价值,结核病诊断及结核菌素试验阴性不能排除结核,短期抗结核治疗具有一定效果。     

广西百色市HIV／TB双重感染现况分析

目的：了解百色市艾滋病病毒／结核杆菌（ HIV／TB ）双重感染的情况,为防控 HIV／TB 双重感染提供参考。方法分析百色市各县（区）艾滋病防治机构和结核病防治机构双向筛查出的HIV／TB 双重感染患者205例的感染特点。结果右江、田阳、田东和平果等4县（区）病例数占全市总发现病例数的91．22％（187／205）,各年龄组发病率比较均衡（P＞0．05）,但病死率有随年龄组的递增有上升的趋势;发病人数最多的职业为农民和民工,占70．24％（144／205）;病死率最高的为离退休人员（20．00％）;HIV／TB双重感染者中HIV的感染途径与性传播有关的占68．29％,为本地的主要传播途径。结论百色市HIV／TB双重感染有其特点,继续全面开展双向筛查工作非常必要。     

66例艾滋病合并肺结核与单纯肺结核临床对照分析

目的:探讨艾滋病合并肺结核病的临床特征。方法:将诊治的艾滋病合并肺结核病并完成治疗及随访的66例患者作为观察组(A组),以同期住院的HIV(-)单纯肺结核患者72例为对照组(B组)进行回顾性分析。结果:A组痰抗酸杆菌阳性率7例,10.61%,显著低于B组,21例,29.17%(P=0.007);A组发热和体重下降较B组更常见,而咳嗽和咯血较B组少见;A组合并肺外结核较B组多见,A组淋巴系统较B组常发生结核病变,A组全身血液播散性结核病的发病率明显高于B组;肺结核的X线、CT表现为弥漫性浸润或粟粒性阴影的,A组多于B组,而A组影像学空洞率显著低于B组;抗痨疗效A组显著低于B组;外周CD4+T淋巴细胞数与结核严重程度相关。结论:HIV(+)/AIDS患者合并肺结核临床表现不典型,结核分枝杆菌检出率低,肺结核的X线、CT表现不典型,抗痨疗效较差。     

2004-2010年广西龙胜各族自治县淋病、梅毒、AIDS/HIV疫情分析

目的:了解龙胜县近7年法定传染病中的梅毒、淋病、AIDS和HIV阳性病例情况,分析其流行特征和规律,为制定防治策略和措施提供科学依据.方法:收集该县2004-2010年法定传染病梅毒、淋病、AIDS/HIV阳性病例疫情资料,采用Excel软件进行统计学分析.结果:全县总人口数为17万多,近7年报告梅毒、淋病、AIDS和HIV阳性病例共1146例,人群年均发病率为95.11/10万,其中淋病368例,梅毒646例,AIDS 35例(死亡10例),HIV阳性97例(死亡22例).以上4种疾病高发年龄在15～44岁年龄组,占总发病人数的68.32%.农民发病人数占61.78%.梅毒、AIDS/HIV阳性病例数近几年呈逐年上升趋势,特别是梅毒和AIDS/HIV阳性病例呈现平行上升的态势.结论:龙胜县梅毒、AIDS/HIV阳性总病例不断增多,其防治任务仍然非常严峻.     

广西部分地区人类免疫缺陷病毒感染者合并丙型肝炎病毒感染情况分析

目的 了解广西人类免疫缺陷病毒(HIV)感染者中HIV/丙型肝炎病毒(HCV)的混合感染率及其HCV RNA的阳性率,为今后HIV患者丙肝筛查及预防提供参考.方法 采用ELISA法检测HIV感染者血清中的丙肝病毒抗体,按结果分成抗-HCV(+)组和抗-HCV(-)组,再用巢式PCR法检测血清的HCV RNA,分析比较HCV RNA阳性率.结果 在300例HIV感染者中,有146例抗-HCV阳性,154例抗-HCV阴性;在抗-HCV阳性组中,HCV RNA的阳性率为78.08％(114/146);在抗-HCV阴性组中,HCV RNA阳性率为26.62％(41/154);ELISA法和巢式PCR法检测HCV感染的符合率为75.67％[(113+114)/300].结论 在广西的HIV感染者中HCV感染状况较严重.对HIV感染者进行丙肝筛查时,为减少漏诊率,建议采用PCR方法检测抗-HCV阴性血清中的HCV RNA.     

我国四川、广西、新疆地区女性性工作者对暴露前预防用药预防HIV感染接受意愿调查

目的 了解我国四川省、新疆维吾尔自治区、广西壮族自治区女性性工作者( FSWs)对暴露前预防用药(Pr-EP)预防人类免疫缺陷病毒(HIV)感染的接受意愿及其影响因素.方法 采用问卷调查的形式,调查对象为四川省、新疆维吾尔自治区、广西壮族自治区的FSWs.调查完成问卷1 478份,有效问卷1 469份(占99.39％).调查内容主要为FSWs对Pr-EP的知晓情况和接受意愿.结果 经调查人员介绍了Pr-EP相关知识后,在Pr-EP安全有效的前提下,共有801人(54.5％)表示“肯定愿意使用”,有196人(13.3％)表示“可能会使用”,Pr-EP使用意愿为67.9％ (997/1469),三个地区间的差异无统计学意义(p＞0.05).经过单因素x2检验和Logistic回归分析,结果显示:Pr-EP的接受意愿的影响因素包括危险自评(OR=1.776,P=0.005)、性服务安全套使用(OR=1.346,P=0.000)、最近三次发生性交易使用安全套的频率(OR=1.519,P=0.003)、是否使用过药物预防性病(OR=1.185,P =0.025)、是否拒绝与不使用安全套的人发生性行为(OR=1.479,P=0.009)、是否会建议朋友接受Pr-EP(OR =5.618,P=0.000).三个地区FSWs对Pr-EP比较关注的是其安全性/不良反应、效果/有效性、费用.结论 坚持使用安全套的FSWs更倾向于接受Pr-EP;应该加大Pr-EP相关知识的宣传力度,提高FSWs对Pr-EP知晓率,进一步提高FSWs对于Pr-EP的接受意愿;同伴教育可能是推广Pr-EP的有效方式.     

Heterosexual risk of HIV infection in China: systematic review and meta-analysis

Background  Heterosexual sex has become the dominant transmission route in China. Recently studies reported high heterogeneity in heterosexual transmission risk in resource-limited countries. The aim of this study was to summarize the risk of HIV transmission among Chinese serodiscordant couples.

Methods  A systematic review and meta-analysis of observational studies of heterosexual HIV transmission among serodiscordant couples in China was conducted. Two reviewers conducted a literature search using the China National Knowledge Infrastructure (CNKI), Chinese Medical Current Contents (CMCC), and Medline databases. Pooled transmission estimates per 100 person-years (PY) were calculated using a random-effects model. Meta-regression analysis and subgroup analysis stratified by study design, transmission direction and period of antiretroviral therapy (ART) availability were conducted to assess the factors associated with transmission.

Results  Eleven eligible studies were identified reporting on 11 984 couples and 405 HIV transmission events. HIV transmission risk from HIV-positive individuals to heterosexual partners was 1.68 (95% CI 0.74–2.62) per 100 PY. Study design did not reach statistical significance in meta-regression analysis. The pooled female-to-male transmission estimate was 1.11 (95% CI 0.09–2.14) per 100 PY and male-to-female transmission estimate was 1.43 (95% CI 0.19–2.68) per 100 PY. The pooled estimate for those before the availability of the Chinese National Free Antiretroviral Therapy Program (2.13 (95% CI 0.00–4.63) per 100 PY) was higher than that for those after the implementation of this program (1.44 (95% CI 0.62–2.26) per 100 PY).

Conclusions  Transmission estimates in China were lower than other developing countries, but higher than developed countries. Research that better defines HIV secondary transmission rates and the associated behavioral, treatment adherence, and health-related risk factors among heterosexual serodiscordant couples in China is needed.

     

Engaging HIV-infected patients in antiretroviral therapy services: CD4 cell count testing after HIV diagnosis from 2005 to 2009 in Yunnan and Guangxi, China

Background  The initiation and expansion of China’s national free antiretroviral therapy program has led to significant improvement of survival among its participants. Success of further scaling up treatment coverage rests upon intensifying HIV screening and efficient linkage of care. Timely CD4 cell count testing after HIV diagnosis is necessary to determine whether a patient meets criteria for antiretroviral treatment, and represents a crucial link to engage HIV-infected patients in appropriate care, which has not been evaluated in China.

Methods  We evaluated all patients ≥16 years who tested HIV positive from 2005 to 2009 in Yunnan and Guangxi. Multivariate Logistic regression models were applied to identify factors associated with lack of CD4 cell count testing within 6 months after HIV diagnosis.

Results  A total of 83 556 patients were included. Over the study period, 30 635 (37%) of subjects received a CD4 cell count within 6 months of receiving the HIV diagnosis. The rate of CD4 cell count testing within 6 months of HIV diagnosis increased significantly from 7% in 2005 to 62% in 2009. Besides the earlier years of HIV diagnosis, negative predictors for CD4 cell count testing in multivariate analyses included older age, not married or unclear marriage status, incarceration, diagnosis at sexual transmitted disease clinics, mode of HIV transmission classified as men who have sex with men, intravenous drug users or transmission route unclear, while minority ethnicity, receipt of high school or higher education, diagnosis at voluntary counseling and testing clinics, and having HIV positive parents were protective.

Conclusions  Significant progress has been made in increasing CD4 testing among newly diagnosed HIV positive patients in Yunnan and Guangxi from 2005–2009. However, a sizable proportion of HIV positive patients still lack CD4 testing within 6 months of diagnosis. Improving CD4 testing, particularly among patients with identified risk factors, is essential to link patients with ART services and optimize treatment coverage.

     

肺结核合并肺曲霉病的临床表现及诊疗分析

目的 探讨肺结核合并肺曲霉病的病因和临床特点,提高本病的诊治水平。方法 选取2012年1月—2016年1月解放军第三〇九医院全军结核病研究所确诊的67例肺结核合并肺曲霉菌感染患者的临床资料进行回顾性分析。结果 67例患者均合并其他基础疾病,如慢性阻塞性肺疾病（COPD）、支气管扩张、糖尿病等。临床表现有发热、咳嗽、咳痰、咯血、呼吸困难等症状。肺结核合并肺曲霉病患者可呈现出实变、结节、空洞、“新月征”等影像学表现,其中“新月征”是肺曲霉病特征性影像学表现。以曲霉菌培养法为标准,对患者痰或支气管肺泡灌洗液进行半乳甘露聚糖（GM）试验检测,敏感度为78.3%（36/46）,准确率为65.7%（44/67）;通过病理活检方法可明确肺曲霉病具体类型,经支气管镜钳夹活检病理诊断慢性空洞性肺曲霉病（CCPA）15例,曲菌球17例,慢性坏死性肺曲霉病（CNPA）13例,曲霉菌结节2例;经外科手术病理确诊CCPA 5例,曲菌球10例,CNPA 2例,曲霉菌结节3例。67例患者在抗结核药物治疗的基础上,给予抗真菌药物治疗,且不少于6个月,方式分为口服和支气管镜下灌注两种,兼以支气管镜介入术和外科手术切除病灶。所有患者在随访复检中未再次出现曲霉菌感染,无病情恶化现象,基本处于稳定。结论 肺结核合并肺曲霉菌感染有多种易感因素,临床表现和影像学改变缺乏特异性,病原菌培养或病理活检仍是诊断金标准。对于肺结核患者,积极治疗原发病,保证患者机体一定的免疫力,对预防曲霉菌感染至关重要。     

HIV相关性瘙痒性丘疹的研究现状

人类免疫缺陷病毒(human immunodeficiency virus,HIV)相关性瘙痒性丘疹(pruritic papular eruption,PPE)是HIV感染者中常见的皮肤表现。HIV-PPE在热带地区发病率较高。临床表现以慢性、瘙痒性、对称性丘疹为特征。但HIV-PPE的病因及发病机制还不清楚,病理特征尚未明确。HIV-PPE与CD4细胞计数下降有一定相关性。目前缺乏有效的治疗方法。     

中国六省儿童HIV感染者的流行病学调查

目的了解中国六省儿童HIV感染者的流行病学状况。方法对6个艾滋病高发省份的儿童感染者进行横断面调查,采集患者人口学、感染途径、诊断时间、临床分期、实验室检测等数据。结果共650例患儿入选,男405例,女245例,平均年龄(7.9±3.2)岁,可能感染到确诊的平均时间间隔为(7.1±3.2)年。依次分布于河南570例(87.7%),广西23例(3.5%),云南21例(3.2%),湖北19例(2.9%),安徽10例(1.5%),山西7例(1.1%)。其中母婴传播488例(75.1%),输血及血制品传播102例(15.7%),静脉吸毒传播3例(0.5%)。以采供血为主要传播途径的省份(包括河南、山西、湖北、安徽)和以静脉吸毒为主要传播途径的省份(包括广西、云南)感染者的平均年龄分别为(8.1±3.2)和(5.4±2.2)岁,两组相比差异有显著性(P<0.001)。178例(39.3%,178/453)符合接受抗病毒治疗标准,其中133例(74.7%,133/178)未接受治疗,45例(25.3%,45/178)采用成人药物治疗。结论母婴传播是儿童感染HIV的主要途径,应当加强我国儿童HIV感染者的诊断和治疗工作。     

老年肺结核CT诊断

目的:探讨老年肺结核的CT表现并评估CT的诊断价值。方法:回顾性分析经手术病理、纤支镜、痰菌培养所证实的56例老年肺结核的CT表现,常规CT平扫和增强扫描,病灶部位2mm薄层扫描。结果:肺内原发病灶56例,结核性空洞38例,干酪性肺炎40例,结核性胸膜炎20例,支气管旁、肺门及纵隔淋巴结肿大17例,粟粒性肺结核5例。老年肺结核的CT征象多表现为形态不一,肿块特征不明显,病变易播散,病灶数目较多,易发生钙化和少增强效应,易合并结核性胸膜炎和心包炎。结论:CT检查在老年肺结核诊断中起重要作用,为老年肺结核的诊断和鉴别诊断提供可靠的依据。     

老年肺结核CT诊断

目的：探讨老年肺结核的CT表现并评估CT的诊断价值。方法：回顾性分析经手术病理、纤支镜、痰菌培养所证实的56例老年肺结核的CT表现，常规CT平扫和增强扫描，病灶部位2mm薄层扫描。结果：肺内原发病灶56例，结核性空洞38例，干酪性肺炎40例，结核性胸膜炎20例，支气管旁、肺门及纵隔淋巴结肿大17例，粟粒性肺结核5例。老年肺结核的CT征象多表现为形态不一，肿块特征不明显，病变易播散，病灶数目较多，易发生钙化和少增强效应，易合并结核性胸膜炎和心包炎。结论：CT检查在老年肺结核诊断中起重要作用，为老年肺结核的诊断和鉴别诊断提供可靠的依据。     

江苏省涂阳肺结核患者治疗依从性现状调查及影响因素分析

目的:探讨江苏省结核病治疗依从性现状并分析其影响因素,为制订有针对性的干预措施提供科学依据?方法:随机抽取13个样本点,各样本点连续性收集2006年1月1日起登记报告的60例涂阳肺结核患者为研究对象,由经过培训的调查员采用结构式调查表进行问卷调查,并分析依从性现状及不规则治疗的影响因素?结果:670名结核病患者在治疗过程中有82人存在不规则服药现象,不规则治疗比例12.2%?不规则服药的主要原因是药物不良反应(37.8%)?患者的文化程度及服药方式是影响依从性的主要影响因素?结论:依从性是当前结核病控制工作的一个重要课题,应当关注重点人群,采取以规范督导为主的综合干预措施降低不规则治疗的风险,提高治愈率?     

Cognitive factors associated with the willingness for HIV testing among pregnant women in China

Background The spread of human immunodeficiency virus/acquired immunodeficiency syndrome （HIV/AIDS） epidemic in the worldwide trend is not contained effectively. The pregnant women infected HIV seriously in the high HIV epidemic areas in China. The transmission of HIV to child may be cut off if HIV positive mother was found early by HIV testing. Pregnant women mandatorily received the HIV counseling and testing services. Most of them did not know the knowledge about HIV prevention and were not willing to receive HIV testing actively. Willingness for HIV testing among pregnant women was investigated, which can help to promote them to take up HIV testing actively. This study assessed the prevalence of the willingness for HIV testing and cognitive factors associated with it. Methods A cross-sectional survey was conducted to 500 pregnant women via face-to-face interviews with anonymous structured questionnaire guided by the Health Belief Model （HBM）. Results The prevalence of the willingness for HIV testing was 58.60%. Perceived higher susceptibility to HIV （multivariate- adjusted odds ratio （ORm）=2.02, 95% confidence interval （CI）： 1.40-5.06）, more knowledge for HIV （ORm=1.92, 95% CI： 1.11-3.87） and perceived less social stigma （ORm=0.80, 95% CI： 0.34-0.91） were associated with higher willingness for HIV testing among pregnant women. Conclusion To prevent HIV mother to children transmission, it is necessary to enhance knowledge for HIV, change cognitive factors and increase willingness for HIV testing among pregnant women.     

Predictors of impaired renal function among HIV infected patients commencing highly active antiretroviral therapy in Jos, Nigeria

Background:

Kidney disease is a common complication of human immunodeficiency virus (HIV) infection even in the era of antiretroviral therapy, with kidney function being abnormal in up to 30% of HIV-infected patients. We determined the predictors of impaired renal function in HIV-infected adults initiating highly active antiretroviral therapy (HAART) in Nigeria.

Materials and Methods:

This was a retrospective study among HIV-1 infected patients attending the antiretroviral clinic at the Jos University Teaching Hospital (JUTH), between November 2005 and November 2007. Data were analysed for age, gender, weight, WHO clinical stage, CD4 count, HIV-1 RNA viral load, HBsAg and anti-HCV antibody status. Estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft-Gault equation. Statistical analysis was done using Epi Info 3.5.1.

Results:

Data for 491 (294 females and 197 males) eligible patients were abstracted. The mean age of this population was 38.8±8.87 years. One hundred and seventeen patients (23.8%; 95% CI, 20.2-27.9%) had a reduced eGFR (defined as <60 mL/min), with more females than males (28.6% vs. 16.8%; P=0.02) having reduced eGFR. Age and female sex were found to have significant associations with reduced eGFR. Adjusted odds ratios were 1.07 (95% CI, 1.04, 1.10) and 1.96 (95% CI, 1.23, 3.12) for age and female sex, respectively.

Conclusions:

Older age and female sex are independently associated with a higher likelihood of having lower eGFRs at initiation of HAART among our study population. We recommend assessment of renal function of HIV-infected patients prior to initiation of HAART to guide the choice and dosing of antiretroviral drugs.     

一例重症肝病/艾滋病病例与HIV携带者和正常对照免疫学差异分析

目的分析1例HIV/HBV双重感染的重症肝病/艾滋病病例与HIV/HCV双重感染病例、HIV携带者和正常对照的免疫学差异。方法随机抽取HIV携带者病例和阴性人群作为对照,应用流式细胞术分析B淋巴细胞、NK细胞、CD4+T淋巴细胞及CD8+T淋巴细胞绝对数;同时分析淋巴细胞活化标志物CD45CD56、CD56CD69、CD4CD38、CD4HLA-DR、CD8CD38、CD8HLA-DR阳性细胞百分率及淋巴细胞坏死/凋亡细胞率。结果相对于HIV/HCV双重感染、HIV携带者及正常对照,该病例各淋巴细胞亚群计数均偏低,而CD45CD56、CD4CD38、CD8CD38阳性细胞亚群均明显偏高;Spearman相关性分析结果显示,总淋巴细胞计数与CD4+T淋巴细胞计数相关性最高(r=0.778,P=0.023),CD8HLA-DR阳性亚群比率与CD4+T淋巴细胞计数相关性最高(r=-0.787,P=0.020);该病例外周血淋巴细胞死亡/凋亡指标与其它病例和正常对照相比并没有明显差别。结论 B细胞、NK细胞、T淋巴细胞各亚群计数结合淋巴细胞活化标志物可以更全面地描述HIV感染者的免疫状态。     

Procedure and clinical assessments of malariotherapy:recent experience in 20 HIV patients

Objective To demonstrate the side effects of malariotherapy and to explore safe procedures in conduct of malariotherapy for human immunodeficiency virus (HIV) infected patients.Methods Twenty HIV/acquired immunodeficiency syndrome (AIDS) patients were selected for the study of malariotherapy and were intravenously infected with Plasmodia vivax to induce therapeutic malaria. Malaria was terminated with chloroquine after 10 -20 malarial febrile episodes. Clinical assessments were made before (baseline), during (malarial phase) and after (post) termination of malaria. The density of Plasmodia in peripheral blood from the HIV/AIDS patients were compared to that from HIV-negative naturally infected malarial patients who donated the blood for the therapeutically induced malaria. CD4 cell baseline levels were correlated to the severity of malarial symptoms and parasitemia.Results There were no significant differences of Plasmodium density between the HIV/AIDS patients injected with P, vivax and the HIV-negative blood donors. However, it was found that the HIV-positive patients had milder malarial symptoms and parasitemia with progressively lower CD4 cell baseline levels. All patients developed every day or every other day fever episodes with headache and shaking chill. These symptoms were well tolerated with the aid of anti-pyretic medications. Spleen and liver enlargement were seen in 15 of 20 and 4 of 20 patients respectively. Transitory liver effects with increase of serum glutamic-pyruvic transaminase were seen in 2 of 20 during malarial phase. Most patients experienced mild to medium anemia and 6 of 20 patients developed thrombocytopenia during malarial phase. All these side effects disappeared after termination of malaria or within one month thereafter. No complications occurred in these patients.Conclusions Therapeutically induced acute vivax malaria was well tolerated in 20 HIV-positive subjects who represented a range of CD4 cell levels from 1868/μ1 to 15/μ1. Malariotherapy did not induce complications while increasing CD4 cell levels in most treated HIV/AIDS patients (results published elsewhere).     

Interferon-gamma treatment kinetics among patients with active pulmonary tuberculosis

Introduction:

Interferon-γ (IFN-γ) is essential for defence against Mycobacterium tuberculosis; however, levels in patients with active tuberculosis (TB) and changes during treatment have not been documented in our tuberculosis patients in Nigeria, hence this study has been carried out.

Objective:

To determine variations, treatment kinetics, and predictive value of IFN-γ levels during treatment of active tuberculosis.

Design:

Patients with pulmonary tuberculosis were recruited and subsequently followed up for 3 months during treatment with anti-TB. Peripheral blood was collected for IFN-γ assays, C-reactive protein and others followed by a Mantoux test. IFN-γ levels produced by stimulation with TB antigens were determined by ELISA and repeated measurement of IFN-γ were done at 1 and 3 months of anti-TB therapy. Chi Associations and correlations between IFN-γ were determined. Regression analysis was done to determine association between serial IFN-γ and treatment outcome.

Results:

We recruited 47 patients with active tuberculosis with a mean age of 34.8 ± 3.6 years and M:F ratio of 1.12:1. Six (11%) were HIV positive. The mean level of IFN-γ induced by TB antigens was 629 ± 114.1 pg/ml, higher for HIV-negative PTB patients compared with HIV-positive PTB patients, 609.78 ± 723.9 pg/ml and 87.88 ± 130.0 pg/ml, respectively, P-value = 0.000. The mean level of IFN-γ induced by TB antigen increased significantly from 629 ± 114.1 pg/ml to 1023.46 + 222.8 pg/ml, P-value = 0.03 and reduced to 272.3 ± 87.7 pg/ml by the third month on anti-TB drugs, P-value = 0.001. Negative correlation was observed between the mean of baseline and chest X-ray involvement, P = 0.03. There was no significant correlation between sputum smear grade with baseline and follow-up IFN-γ levels. Three-month IFN-γ level among cured patients were higher than those with treatment failure, regression analysis showed that it does not predict outcome.

Conclusion:

IFN-γ may be useful in early detection and monitoring response; however, large scale studies are needed.