Interferon -y and interleukin-4 in Hiv infected patients under Ampath program with Mycobacterium Tuberculosis at the Moi Teaching and Referral Hospital, Eldoret, Kenya.

Abstract

In tuberculosis, cellular immunity is considered to be responsible for the eradication of infection in animal models, the balance between Th l-type cytokines, especially interferon gamma (IFN-y), and Th2-type cytokines, primarily interleukin (IL-4), seems crucial for these effects. Reports on Th l-type and Th2-type cytokines in human tuberculosis are conflicting. The ThllTh2 cytokines balance is crucial determinant of pathology in both HIV-Aids and tuberculosis patients because protective immunity in TB depends on a cellular host response, with an important role for CD4 T- helper cells. Study objectives To determine ThllTh2 shift in HIV-I infected MTB patients under AMPATH program in MTRH. Methodology: This was a cross-sectional study where 21 HIV -1 infected patients with MTB attending the MTRH AMP ATH clinic consecutively over a period of three months and newly diagnosed with pulmonary tuberculosis and who were eligible for the study gave informed consent. CD4 ICD8 counts were determined using TriTEST CD3 FITCICD4 PE/CD45 PerCP test. IFN-y and IL-4 Cytokines level were analyzed using BDTM Cytometric Bead Array and viral loads determined using COBAS TaqMan HIV-I Test kit. Results: In patients with CD4 counts <200 cells/ul the plasma levels of IFN-y (median 19.8pg/ml) were significantly lower than that measured in patients with CD4 counts> 200 cells/ul (median 29.8pg/ml). IL-4 levels in patients with < 200 cells IJlI were (median 48pg/ml) higher than those with CD4 >200 cells/ul (median36.6pg/ml). Patients with CD4< 200 cells/ul, had a statistically significant correlation between IL-4 and Viral load(r=0.812, p=0.004). Patients with CD4=>200 cells/ul, had a statistically significant correlation between IL-4 and viral load (r=0.802 p=0.004). There was a significant correlation between IFN- y and HIV viral loads (r=0.792, p=0.004) and between IFN- y and IL-4 (r=0.679, p=0.022) were significant Conclusion: There is a reduction in the levels of IFN y in HIV infected patients who are smear positive for MTB and CD4 counts below 200 cells/ul compared to those with CD4 above 200 cells/pi while the levels of IL-4 are higher in patients with <200 cells/ul than those with CD4 >200 cells/ul.