Immune Responses in Patients Co-Infected with HIV and Mycobacterium Tuberculosis Attending Tb Clinic in Kericho County Hospital, Kenya
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Date
2018
Authors
Cherono, Eunice
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
Tuberculosis, caused by Mycobacterium tuberculosis is the most common opportunistic
infection in HIV/AIDS patients globally and more cases in sub-Saharan Africa, Kenya
included. It is the main cause of morbidity and mortality in adults aged between 18 and
49 years. CD4+ T cell count is a crucial marker of immunologic integrity and therefore
clinical signs of TB vary with the CD4+ T cell counts in HIV-TB patients. It has been
used with viral load as markers of disease progression. There is therefore a need to
establish immune responses in patients co-infected with HIV and Mycobacterium
tuberculosis specifically using CD4+T cell counts and viral load counts when they are
undergoing TB therapy. The study was carried out in Kericho County Hospital with
HIV-TB coinfected subjects. Tuberculosis monoinfected patients and the normal
standard references were use as controls. Demographic characteristics of patients
including age, sex, occupation and marital status were obtained by use of
questionnaires. The blood samples were obtained at the start of the TB treatment and
after completion of the anti-TB drugs. FACS Calibur flow cytometer was used to count
the CD4+ T cells. The viral loads counts were obtained from the hospital patient’s
records after a period of six months. The data that was obtained was entered in SPSS
and analysis was carried out to determine relationship between the coinfection and these
various variables. Descriptive statistics such as mean, median, variance, standard
deviation and percentages were used to determine socio demographic characteristics,
the CD4+ T cells and Viral load counts were compared at the beginning and at the
completion of TB chemotherapy using median, range, percentile ranks, quartile ranks
and paired sample test. The results were then presented in tables, Charts and graphs. A
total of 323 HIV-TB co-infected persons were enrolled in the study. Their age ranged
from 18 to 74 years. A total of 54.8% of study participants were females while 45.2%
were males, 92.6 % were married. As far as education level is concerned, 44.6 %
reported to have achieved primary school education while 39.0 % and 16.4 % had
secondary and tertiary education level respectively. Concerning their occupations, 14.9
%, 10.2 % and 9.6 % respondents reported that they were engaged in small business,
farming and casual labour respectively. Security personnel and accountants constituted
7.1 % and 4.6 % respectively, 78.0 % and 22.0 % had pulmonary and extrapulmonary
tuberculosis respectively. There was a general increase in CD4+ T cell counts after TB
chemotherapy irrespective of the type of TB. Statistical significant difference was
observed in the median CD4+Tcell counts in patients with any form of TB before and
after treatment median (IQR) 88(35-180) and 398(340-490) cells/μl, respectively
(P<0.001). The median (IQR) viral load was 256,789 (49,000-460,870) and 19 (19-86)
copies/μl at pretreatment and post treatment respectively (P<0.001).The findings
revealed an inverse relation between CD4+ T cell counts and viral copies in the TBHIV
coinfected patients after treatment. The finding of this study are important in
informing the ministry of health on the most vulnerable population as well as the
importance of TB chemotherapy in strengthening immunity by restoring CD4 T cell
counts and reducing replication of virus.
Description
A Thesis Submitted in Partial Fulfillment of the Requirements for the Award of the Degree of Master of Science (Immunology) in the School of Pure and Applied Sciences of Kenyatta University. October, 2018