Main Article Content
Tuberculosis, HIV, CD4+, Co-infection, Acquired immune deficiency syndrome (AIDS), Erythrocytes sedimentation rate (ESR), Differential leukocytes count (DLC)
Objectives: To assess and correlate the hematological and immunopathological profiles of HIV patients with pulmonary TB.
Study Design: A prospective observational study was conducted at the Punjab AIDS Control Program (PACP) and provincial reference TB control laboratory in Lahore.
Place and Duration of the Study: 15th August 2015 to 8th March 2018
Methodology: A data collection form was generated, and socio-economic and demographic information was collected from enrolled subjects. The total number of patients identified was 560, of whom n=510 got HIV. All patients aged 4 to 80 years were included. Blood profiles of the patients were collected, and the Immuno-chromatographic (ICT) Technique was performed for the screening of blood samples; for that, Alere DetermineHIV-1/2 Ag/Abs Combo strips were used. This strip could detect HIV-1/2 antigen (p24) and HIV1/2 antibodies simultaneously. The Gene Xpert detects the DNA sequences that are specific for M. tuberculosis and RIF resistance by PCR. The data was entered into an Excel sheet and then analyzed with the help of Statistical analysis tools Statistical Package for Social Science (SPSS).
Results: A total number of five hundred ten (n=510) HIV patients, including males (n=381), females (n=116), and transgender (n=13). Among the enrolled individuals, 64.90% were married, being the highest, and 2.15% were widowed/divorced and were the least. The prevalence of HIV with T.B was significantly higher among male patients. The mean CD4+ and CD8+ count in HIV patients was 429.5 cells/mm3 and 808.4 cells/mm3. CD8+T cell means were high in newly diagnosed and recurrent TB patients. The mean CD4+and CD8+ count in HIV patients co-infected with TB was 200.7 cells/mm3 and 941.6 cells/mm3. It was also recorded that, as compared to a female, the male populations have a lower mean CD4+T cell count.
Conclusion: The findings of this study have revealed that HIV/TB co-infection results in the depletion of CD4+ cells, resulting in susceptibility to other infections. In the current scenario, most cases of TB-HIV co-infection have CD4+ count and Hb lower compared to only HIV-infected patients. Male has a high prevalence of TB-HIV co-infected compared to females. For optimal therapy, the research suggests that HIV patients co-infected with TB be evaluated regularly.
2. Ahmed, A., F.K. Hashmi, and G.M. Khan. 2019. HIV outbreaks in Pakistan. The Lancet HIV. 6:e418.
3. Ahmed, N., A. Rizvi, A. Naeem, W. Saleem, A. Ahmed, S. Parveen, and M. Ilyas. 2020. COVID-19 and public awareness. The Professional Medical Journal. 27:1710-1716.
4. Aibibula, W., J. Cox, A.-M. Hamelin, H. Mamiya, M.B. Klein, and P.J.A.c. Brassard. 2016. Food insecurity and low CD4 count among HIV-infected people: a systematic review and meta-analysis. 28:1577-1585.
5. Akinbami, A.A., S.O. Ajibola, K.A. Rabiu, A.A. Adewunmi, A.O. Dosunmu, A. Adediran, V.O. Osunkalu, B.I. Osikomaiya, and K.A. Ismail. 2013. Hematological profile of normal pregnant women in Lagos, Nigeria. International journal of women's health. 5:227.
6. Amilo, G., S. Meludu, P. Ele, C. Ezechukwu, C. Onyenekwe, M.I.J.A.i.L.S. Chukwu, and Technology. 2013. Haematologic indices in pulmonary tuberculosis with or without HV Co-infection in South Eastern Nigeria. 11:1-7.
7. Baghel, D., M. Tilkar, U. Singh, A. Maravi, K.J.E.J.o.M. Praveen, and C. Medicine. 2021. To Study Haematological Profile In Patient Of Pulmonary Tb With And Without Hiv Co-Infection. 8:1709-1718.
8. Barletta, J.M., D.C. Edelman, and N.T. Constantine. 2004. Lowering the Detection Limits of HIV-1 Viral Load Using Real-Time Immuno-PCR for HIV-1 p24 Antigen. American Journal of Clinical Pathology. 122:20-27.
9. Batool, Y., G. Pervaiz, A. Arooj, and S. Fatima. 2022. Hematological manifestations in patients newly diagnosed with pulmonary tuberculosis. Pakistan Journal of Medical Sciences. 38.
10. Bruchfeld, J., M. Correia-Neves, and G.J.C.S.H.p.i.m. Källenius. 2015. Tuberculosis and HIV coinfection. 5:a017871.
11. Bukhari, B., M. Naveed, S.I. Makhdoom, K. Jabeen, M.F. Asif, H. Batool, N. Ahmed, and Y.Y. Chan. 2021. A comparison between organic and inorganic nanoparticles: Prime nanoparticles for tumor curation. Nano. 16:2130011.
12. Eggena, M.P., B. Barugahare, M. Okello, S. Mutyala, N. Jones, Y. Ma, C. Kityo, P. Mugyenyi, and H.J.T.J.o.i.d. Cao. 2005. T cell activation in HIV-seropositive Ugandans: differential associations with viral load, CD4+ T cell depletion, and coinfection. 191:694-701.
13. Gelaw, Y.A., G. Williams, R.J. Soares Magalhães, C.F. Gilks, Y.J.A. Assefa, and Behavior. 2019. HIV prevalence among tuberculosis patients in sub-Saharan Africa: a systematic review and meta-analysis. 23:1561-1575.
14. Gounder, C., F.C. De Queiroz Mello, M.B. Conde, W.R. Bishai, A.L. Kritski, R.E. Chaisson, and S.E. Dorman. 2002. Field evaluation of a rapid immunochromatographic test for tuberculosis. J Clin Microbiol. 40:1989-1993.
15. Gyar, S., E. Dauda, and C. Reuben. 2014. Prevalence of tuberculosis in HIV/AIDS patients in Lafia, Central Nigeria. Int. J. Curr. Microbiol. Appl. Sci. 3:831-838.
16. Hospital, M.M.I. 2022. HIV in Pakistan: Trends and Statistics Overview: History of HIV/AIDS in Pakistan?
17. Javed, I., M.T. Javed, Z. Mahmood, M. Riaz, R. Iqbal, and A. Rasul. 2018a. Hematological profiling of tuberculosis-infected and co-morbid patients: a study carried out in central Punjab, Pakistan. European Journal of Inflammation. 16:2058739218818684.
18. Javed, I., M.T. Javed, Z. Mahmood, M. Riaz, R. Iqbal, and A.J.E.J.o.I. Rasul. 2018b. Hematological profiling of tuberculosis-infected and co-morbid patients: a study carried out in central Punjab, Pakistan. 16:2058739218818684.
19. Khan, A., A. Tahir, M. Sohail Afzal, R.M. Kamran Shabbir, S. Saleem, and H. Ahmed. 2021. HIV is an emerging health challenge in Pakistan: risk factors and management strategies. Tropical Doctor. 51:135-136.
20. Khan, S., M.A. Rai, M.R. Khanani, M.N. Khan, and S.H. Ali. 2006. HIV-1 subtype A infection in a community of intravenous drug users in Pakistan. BMC infectious diseases. 6:164.
21. Khuawar, S.M., A.H. Laghari, and A.H.J.N.E.A.B. Samoo. 2019. Prevalence of HIV Infection Among Tuberculosis Patients in Sindh, Pakistan. 30:109.
22. Lallemand, F., N. Desire, W. Rozenbaum, J.-C. Nicolas, and V. Marechal. 2000. Quantitative Analysis of Human Herpesvirus 8 Viral Load Using a Real-Time PCR Assay. Journal of Clinical Microbiology. 38:1404-1408.
23. Lawson, L., M.A. Yassin, T.D. Thacher, O.O. Olatunji, J.O. Lawson, T.I. Akingbogun, C.S. Bello, L.E. Cuevas, and P.D. Davies. 2008. Clinical presentation of adults with pulmonary tuberculosis with and without HIV infection in Nigeria. Scandinavian journal of infectious diseases. 40:30-35.
24. Li, C.-X., Y.-Y. Li, L.-P. He, J. Kou, J.-S. Bai, J. Liu, B. Tian, L.-J. Cao, K.-H. Wang, and Y.-Q.J.B.i. Kuang. 2019. The predictive role of CD4+ cell count and CD4/CD8 ratio in immune reconstitution outcome among HIV/AIDS patients receiving antiretroviral therapy: an eight-year observation in China. 20:1-8.
25. Marfani, W.B., H.A. Khan, M. Sadiq, and O. Outani. 2022. The rise in HIV cases in Pakistan: Prospective implications and approaches. Annals of Medicine and Surgery (2012). 81:104492-104492.
26. Marrazzo, J.M., C. Del Rio, D.R. Holtgrave, M.S. Cohen, S.C. Kalichman, K.H. Mayer, J.S. Montaner, D.P. Wheeler, R.M. Grant, and B. Grinsztejn. 2014. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society–USA Panel. Jama. 312:390-409.
27. Mba, C.O., R.B. Jacob, M.B. Green, and L.U. Zebedee. 2019. Hematological Profile of Pregnant Women in Port Harcourt, Nigeria. International Journal of Translational Medical Research and Public Health. 3:1-10.
28. McShane, H.J.I.j.o.S., and AIDS. 2005. Co-infection with HIV and TB: double trouble. 16:95-101.
29. MedicalDeviceDepot. Alere HIV-1/2 Ag/Ab Combo.
30. Murray, P.R., K.S. Rosenthal, and M.A. Pfaller. 2020. Medical Microbiology E-Book. Elsevier Health Sciences.
31. Naghavi, M., H. Wang, R. Lozano, A. Davis, X. Liang, and M. Zhou. 2015. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 385:117-171.
32. Nguyen, T.A., L.T. Hoang, V.Q. Pham, and R.J.A. Detels. 2001. Risk factors for HIV‐1 seropositivity in drug users under 30 years old in Haiphong, Vietnam. 96:405-413.
33. Nosik, M., K. Ryzhov, I. Rymanova, A. Sobkin, A. Kravtchenko, U. Kuimova, V. Pokrovsky, V. Zverev, and O. Svitich. 2021. Dynamics of plasmatic levels of pro-and anti-inflammatory cytokines in HIV-infected individuals with M. tuberculosis co-infection. Microorganisms. 9:2291.
34. Obeagu, E.I., B.N. Esimai, G.U. Obeagu, O. Ochiabuto, E.F. Chukwurah, I.S. Ekelozie, and K.C. Ochei. 2020. Evaluation of Some Cytokines, CD4, Hepcidin, Iron Profile and Some Haematological Parameters of Pulmonary Tuberculosis Patients Coinfected with HIV in Southeast of Nigeria.
35. Ogunmola, O.J., Y.O. Oladosu, and M.A. Olamoyegun. 2014. Relationship between socioeconomic status and HIV infection in a rural tertiary health center. HIV/AIDS (Auckland, NZ). 6:61.
36. Parsons, L.M., Á. Somoskövi, C. Gutierrez, E. Lee, C. Paramasivan, A.l. Abimiku, S. Spector, G. Roscigno, and J. Nkengasong. 2011. Laboratory diagnosis of tuberculosis in resource-poor countries: challenges and opportunities. Clinical microbiology reviews. 24:314-350.
37. Ramzan, M., M.I. Karobari, A. Heboyan, R.N. Mohamed, M. Mustafa, S.N. Basheer, V. Desai, S. Batool, N. Ahmed, and B. Zeshan. 2022. Synthesis of silver nanoparticles from extracts of wild ginger (Zingiber zerumbet) with antibacterial activity against selective multidrug resistant oral bacteria. Molecules. 27:2007.
38. Riou, C., E. Du Bruyn, S. Ruzive, R.T. Goliath, C.S. Lindestam Arlehamn, A. Sette, A. Sher, D.L. Barber, and R.J. Wilkinson. 2020. Disease extent and anti‐tubercular treatment response correlates with Mycobacterium tuberculosis‐specific CD4 T‐cell phenotype regardless of HIV‐1 status. Clinical & translational immunology. 9:e1176.
39. Riou, C., C. Stek, and E.D. Bruyn. 2019. Immune Responses to Mycobacterium tuberculosis and the Impact of HIV Infection. In HIV and Tuberculosis. Springer. 57-72.
40. Rizvi, A., M.U. Saeed, A. Nadeem, A. Yaqoob, A.A. Rabaan, M.A. Bakhrebah, A. Al Mutair, S. Alhumaid, M. Aljeldah, and B.R. Al Shammari. 2022. Evaluation of Bi-Lateral Co-Infections and Antibiotic Resistance Rates among COVID-19 Patients in Lahore, Pakistan. Medicina. 58:904.
41. Setty, H.G., M. Kumar, and I.K. Hewlett. 2014. Point of care technologies for HIV. AIDS research and treatment. 2014.
42. Shaw, J.A., E.M. Irusen, A.H. Diacon, and C.F. Koegelenberg. 2018. Pleural tuberculosis: a concise clinical review. The clinical respiratory journal. 12:1779-1786.
43. Shen, F., B. Sun, J.E. Kreutz, E.K. Davydova, W. Du, P.L. Reddy, L.J. Joseph, and R.F. Ismagilov. 2011. Multiplexed Quantification of Nucleic Acids with Large Dynamic Range Using Multivolume Digital RT-PCR on a Rotational SlipChip Tested with HIV and Hepatitis C Viral Load. Journal of the American Chemical Society. 133:17705-17712.
44. Shenoy, V.P., and C. Mukhopadhyay. 2014. Rapid Immunochromatographic Test for the Identification and Discrimination of Mycobacterium tuberculosis Complex Isolates from Non-tuberculous Mycobacteria. J Clin Diagn Res. 8:Dc13-15.
45. Siddiq, A., A.K. Naveed, N. Ghaffar, M. Aamir, and N. Ahmed. 2023. Association of Pro-Inflammatory Cytokines with Vitamin D in Hashimoto’s Thyroid Autoimmune Disease. Medicina. 59:853.
46. Ştefanescu, S., R. Cocoş, A. Turcu-Stiolica, B. Mahler, A.-D. Meca, A.M.C. Giura, M. Bogdan, E.-S. Shelby, G. Zamfirescu, and C.-G. Pisoschi. 2021. Evaluation of prognostic significance of hematological profiles after the intensive phase treatment in pulmonary tuberculosis patients from Romania. PloS one. 16:e0249301.
47. Talati, N.J., U. Seybold, B. Humphrey, A. Aina, J. Tapia, P. Weinfurter, R. Albalak, and H.M. Blumberg. 2009. Poor concordance between interferon-γ release assays and tuberculin skin tests in diagnosis of latent tuberculosis infection among HIV-infected individuals. BMC infectious diseases. 9:1-9.
48. Tan, H.Y. 2016. Immunological determinants of tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) in HIV-infected patients on antiretroviral therapy/Tan Hong Yien. University of Malaya.
49. Ukpe, I., and L. Southern. 2006. Erythrocyte sedimentation rate values in active tuberculosis with and without HIV co-infection. South African Medical Journal. 96:427-428.
50. WHO. 2022. HIV.
51. Wolday, D., Y. Kebede, D. Legesse, D.S. Siraj, J.A. McBride, M.J. Kirsch, and R.J.P.o. Striker. 2020. Role of CD4/CD8 ratio on the incidence of tuberculosis in HIV-infected patients on antiretroviral therapy followed up for more than a decade. 15:e0233049.
52. Yaranal, P.J., T. Umashankar, and S.G.J.I.J.H.R.S. Harish. 2013. Hematological profile in pulmonary tuberculosis. 2:50-55.
53. Yusof, W., A.A. Irekeola, Y. Wada, E.N.S. Engku Abd Rahman, N. Ahmed, N. Musa, M.F. Khalid, Z.A. Rahman, R. Hassan, and N.Y. Yusof. 2021. A global mutational profile of SARS-CoV-2: a systematic review and meta-analysis of 368,316 COVID-19 patients. Life. 11:1224.