Inflammatory cytokines and cell actvaton markers in HIV and HIV/TB co-infected patents atending AMPATH clinic at MTRH-Eldoret, Kenya

Abstract

Background: Infecton with HIV and TB leads to inflammaton. Markers of inflammaton include TNF-α, IFN-γ, CD38 and HLA-DR. In HIV infecton these markers create an environment which favours reactvaton of latent TB to TB disease in patents on HAART. The markers TNF-α, IFN-γ, CD38, HLA-DR and CD4 cell count can be used to predict possible reactvaton of latent TB to disease in HIV patents on HAART. The level of these inflammatory markers in HIV and HIV/TB co-infecton is unknown. The purpose of this study was to investgate inflammatory markers TNF-α, IFN-γ, CD38, and HLA-DR levels in HIV and HIV/TB coinfected patents atending AMPATH clinic at MTRH-Eldoret. Objectve: To determine inflammatory cytokines and cell actvaton markers in HIV and HIV/TB co-infected patents atending AMPATH clinic at MTRH-Eldoret. Methods: This was a cross sectonal comparatve study of 168 patents comprising of 84 HIV/TB co-infected and 84 HIV only patents who had been on HAART for more than 1 year. Clinical and demographic informaton was obtained from the patents hospital fles and interview guide. Blood samples from each patent were collected into EDTA tubes and plasma separated within 2 hours of collecton at 3,000 r.p.m for 3 minutes then kept at -800C untl analysis. Actvaton markers CD38, HLA DR and CD4 count were analysed by flow Cytometry (BD FAC’S calibur®) on whole blood samples. Analysis of the inflammatory cytokines (TNF-α and IFN-γ) were done on the plasma samples by ELISA (Genway’s®). The levels of inflammatory markers in the two groups were compared. Data was analysed using STATA version 13. P-value ≤ 0.05 was considered signifcant. Findings: The mean age for both HIV/TB and HIV patents was 42 years. The median (IQR) levels for TNF-α (pg/ml) was 7.26 (6.76- 8.12), IFN-γ (pg/ml) 26.3 (25.18- 27.22), CD38(%) 4.36 (2.06-6.31), HLA-DR (%) 92.44 (90.52-95.51) and CD4 (cells/mm3) 231 (117-350) in HIV/TB co-infected patents, while in HIV patents the levels were TNF-α 10.72 (8.12-12.13), IFN-γ 25.40 (23.59-27.67), CD38 5.94 (4.44-7.41), HLA-DR 93.33 (90.24-96.56) and CD4 383 (318-543). HIV only patents had higher levels of TNF-α (p=<0.001), CD38% (p=0.0002) and CD4 (p=<0.001) compared to those of TB/HIV co-infected patents. No signifcant differ-ence was observed in the levels of IFN-γ and HLA-DR (p=0.1559) and (p=0.1754) respectvely. Conclusion: Higher levels of inflammatory markers were found in HIV only patents compared to HIV/TB co-infected patents. This high level of inflammaton leads to TB-reactvaton.