Immune Responses In Patients Co-Infected With Hiv And Mycobacterium Tuberculosis Attending Tb Clinic In Kericho County Hospital, Kenya

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