Por favor, use este identificador para citar o enlazar este ítem:
https://www.arca.fiocruz.br/handle/icict/28909
Tipo
ArtículoDerechos de autor
Acceso abierto
Fecha del embargo
2019-09-18
Colecciones
- INI - Artigos de Periódicos [3460]
Metadatos
Mostrar el registro completo del ítem
BIOMARKERS ASSOCIATED WITH DEATH AFTER INITIATING TREATMENT FOR TUBERCULOSIS AND HIV IN PATIENTS WITH VERY LOW CD4 CELLS
Human Immunodeficiency Virus
Innate immunity
Mycobacterium tuberculosis
Nutrition biomarkers
Predictors of mortality
Timing of antiretroviral therapy
Autor
Afiliación
University of Southern California. Keck School of Medicine. Los Angeles, California, USA.
University of Southern California. Keck School of Medicine. Los Angeles, California, USA.
Harvard School of Public Health. Boston, Massachusetts, USA.
University of Southern California. Keck School of Medicine. Los Angeles, California, USA.
Harvard School of Public Health. Boston, Massachusetts, USA.
Social & Scientific Systems Inc.. Silver Springs, Maryland, USA.
Moi University Clinical Research Center. Eldoret, Kenya.
Durban University of Technology. Enhancing Care Foundation. Durban, South Africa.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
University of California San Francisco. San Francisco, California, USA.
Rush Presbyterian Medical Center. Chicago, Illinois, USA.
University of Southern California. Keck School of Medicine. Los Angeles, California, USA.
Harvard School of Public Health. Boston, Massachusetts, USA.
University of Southern California. Keck School of Medicine. Los Angeles, California, USA.
Harvard School of Public Health. Boston, Massachusetts, USA.
Social & Scientific Systems Inc.. Silver Springs, Maryland, USA.
Moi University Clinical Research Center. Eldoret, Kenya.
Durban University of Technology. Enhancing Care Foundation. Durban, South Africa.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
University of California San Francisco. San Francisco, California, USA.
Rush Presbyterian Medical Center. Chicago, Illinois, USA.
Resumen en ingles
Background: The risk of short-term death for treatment naive patients dually infected with Mycobacterium tuberculosis and HIV may be reduced by early anti-retroviral therapy. Of those dying, mechanisms responsible for fatal outcomes are unclear. We hypothesized that greater malnutrition and/or inflammation when initiating treatment are associated with an increased risk for death. Methods: We utilized a retrospective case-cohort design among participants of the ACTG A5221 study who had baseline CD4 < 50 cells/mm3. The case-cohort sample consisted of 51 randomly selected participants, whose stored plasma was tested for C-reactive protein, cytokines, chemokines, and nutritional markers. Cox proportional hazards models were used to assess the association of nutritional, inflammatory, and immunomodulatory markers for survival. Results: The case-cohort sample was similar to the 282 participants within the parent cohort with CD4 <50 cells/mm3. In the case cohort, 7 (14%) had BMI < 16.5 (kg/m2) and 17 (33%) had BMI 16.5-18.5(kg/m2). Risk of death was increased per 1 IQR width higher of log10 transformed level of C-reactive protein (adjusted hazard ratio (aHR) = 3.42 [95% CI = 1.33-8.80], P = 0.011), interferon gamma (aHR = 2.46 [CI = 1.02-5.90], P = 0.044), MCP-3 (3.67 [CI = 1.08-12.42], P = 0.037), and with IL-15 (aHR = 2.75 [CI = 1.08-6.98], P = 0.033) and IL-17 (aHR = 3.99 [CI = -1.06-15.07], P = 0.041). BMI, albumin, hemoglobin, and leptin levels were not associated with risk of death. Conclusions: Unlike patients only infected with M. tuberculosis for whom malnutrition and low BMI increase the risk of death, this relationship was not evident in our dually infected patients. Risk of death was associated with significant increases in markers of global inflammation along with soluble biomarkers of innate and adaptive immunity.
Palabras clave en ingles
Adaptive immunityHuman Immunodeficiency Virus
Innate immunity
Mycobacterium tuberculosis
Nutrition biomarkers
Predictors of mortality
Timing of antiretroviral therapy
Compartir