Dynamics of plasma cytokine levels in patients with advanced HIV infection and active tuberculosis: Implications for early recognition of patients with poor response to anti-tuberculosis treatment
Journal
AIDS
Journal Volume
13
Journal Issue
8
Pages
935-941
Date Issued
1999
Author(s)
Abstract
Objective: To examine whether the serial measurement of plasma cytokine levels can assist in the early recognition of AIDS/tuberculosis patients with poor response to anti-tuberculosis treatment. Design: Longitudinal, prospective cohort study. Setting: A university hospital, the largest centre for HIV/AIDS patients in Taiwan. Methods: Between January 1997 and September 1998, 25 consecutive patients with advanced HIV infection and suspected tuberculosis were enrolled in the study. Plasma samples were obtained on day 1 (baseline), 3, 7 and 14 of anti-tuberculosis treatment and the levels of tumour necrosis factor-α (TNF-α) were measured. Patients were classified as either responders or non-responders according to the results of assessment of symptoms and follow-up cultures during the sixth and eighth week of anti-tuberculosis treatment. Thirty consecutive HIV-negative tuberculosis patients were also enrolled in the study. Results: The data of a total of 16 AIDS patients (median CD4 cell count 16 x 106/l; 12 responders and four non-responders) and 21 HIV-negative patients (16 responders and five non-responders), whose tuberculosis was culture-proven, were included for analysis. In responders, TNF-α levels declined remarkably within the first week of anti-tuberculosis treatment; however, the decline of TNF-α levels in non-responders was significantly less [the median ratio of TNF-α level on day 7 to that at baseline was 0.32 versus 0.85 (P < 0.001) in AIDS patients; 0.34 versus 0.80 (P = 0.001) in HIV-negative patients). The lack of a ? 50% reduction in pre-treatment TNF-α levels during the first week of treatment was strongly associated with a poor response to anti-tuberculosis treatment (P = 0.001 in AIDS patients; P < 0.001 in HIV-negative patients). Conclusion: Serial measurement of plasma TNF-α levels may help to assess the response to anti-tuberculosis treatment in AIDS patients, in spite of very low CD4 cell counts. Failure of TNF-α levels to decline by ? 50% of pre-treatment levels in the first week of treatment may be an early surrogate marker of a poor response.
SDGs
Other Subjects
cd4 antigen; cytokine; tuberculostatic agent; tumor necrosis factor alpha; acquired immune deficiency syndrome; adult; article; bacterium culture; cohort analysis; early diagnosis; female; follow up; human; human cell; human immunodeficiency virus infection; leukocyte count; major clinical study; male; priority journal; prospective study; tuberculosis; Adult; AIDS-Related Opportunistic Infections; Antitubercular Agents; Cohort Studies; Cytokines; Female; Humans; Interleukin-10; Longitudinal Studies; Male; Microbial Sensitivity Tests; Mycobacterium tuberculosis; Prospective Studies; Treatment Outcome; Tuberculosis; Tumor Necrosis Factor-alpha
Type
journal article