Immunoglobulins and predicted mortality in clinical course of concomitant HIV and TB infection

Cover Page


Cite item

Full Text

Abstract

A search for prognostic markers of HIV and tuberculosis coinfection (HIV/TB), especially in case of Mycobacterium tuberculosis multidrug resistance (MDR MBT) associated with low rates of TB eradication, is of relevance in connection with the problem of choosing adequate anti-TB therapy which is able to decrease mortality. 113 HIV/TB patients aged 24 to 58 years were examined: 70 males and 43 females hospitalized at the Novokuznetsk TB Clinic during the 2017—2019 period. MDR MBT (concomitant resistance to Isoniazid and Rifampicin) was found in 50 patients (12 patients with MDR MBT had additional resistance to Fluoroquinolones) aged 24 to 54 years — 31 males and 19 females. The control group consisted of 49 healthy individuals aged 27 to 72 years (26 females and 23 males) lacking focal and systemic infections with moderately pronounced age-related changes. In plasma samples, concentration of total (non-specific) immunoglobulins of classes E, M, G, A (including secretory immunoglobulin A, sIgA) were measured by using enzyme-linked immunosorbent assay. Data statistical processing was performed by using licensed software packages InStatII, Microsoft Excel, IBM SPSS Statistics 22. An extended range of individual variability in count of peripheral blood CD4 lymphocytes was revealed both among non-survivor and survivor patients with HIV/TB examined, being a drawback of using such parameter as lethality predictor. It was found that the serum level of total IgE, IgM, IgG, IgA and sIgA in patients with HIV/ TB was higher than that one in control group, whereas in non-survivor vs. survivor patients the concentration of IgE and sIgA was elevated. The coefficient of disease outcome prediction (CP) for patients with HIV/TB and MDR MBT was calculated being equal to the ratio of the multiplication of serum concentration of IgE, IgM, IgA and secretory IgA to CD4 lymphocyte count (CP = IgE x IgM x IgA x sIgA/CD4). CP higher than 200 was detected in 77% non-survivor and 6% of survivor patients. The relative risk of death with CP > 200 was very high (OR = 56.7, p < 0.0001) being 8.5 times higher than that one upon CD4 < 200 (OR = 6.7, p = 0.0237). A positive correlation between CP and lethal outcome was more valuable than that of CD4. The data presented allow us to propose CP for clinical use as an effective prognostic criterion for HIV/TB with MDR MBT.

 

About the authors

N. V. Mal’tseva

Novokuznetsk State Institute for Further Training of Physicians, Branch Campus of the FSBEI FPE RMACPE MOH

Author for correspondence.
Email: ninamaltseva2015@mail.ru
ORCID iD: 0000-0001-6857-7453

Nina V. Maltseva - PhD, MD (Biology), Head of the Research Laboratory of Molecular Biology, Novokuznetsk State Institute for Further Training of Physicians, Branch Campus of the FSBEI FPE RMACPE MOH.

654005, Kemerovo Region, Novokuznetsk, Stroitelei pr., 5.

Phone: +7 (384) 345-56-41; Fax: +7 (384) 345-42-19

Russian Federation

I. B. Victorova

Novokuznetsk State Institute for Further Training of Physicians, Branch Campus of the FSBEI FPE RMACPE MOH

Email: irinaviktoroff@mail.ru
ORCID iD: 0000-0002-5826-5517

PhD (Medicine), Associate Professor, Phthisiopulmonology Department, Novokuznetsk State Institute for Further Training of Physicians, Branch Campus of the FSBEI FPE RMACPE MOH.

Novokuznetsk.

Russian Federation

O. M. Kazantseva

Novokuznetsk State Institute for Further Training of Physicians, Branch Campus of the FSBEI FPE RMACPE MOH

Email: lelya.kazantseva.94@mail.ru
ORCID iD: 0000-0002-7677-5334

Junior Researcher, Research Laboratory of Molecular Biology, Novokuznetsk State Institute for Further Training of Physicians, Branch Campus of the FSBEI FPE RMACPE MOH.

Novokuznetsk.

Russian Federation

S. V. Arkhipova

Novokuznetsk State Institute for Further Training of Physicians, Branch Campus of the FSBEI FPE RMACPE MOH

Email: cvarx@mail.ru
ORCID iD: 0000-0002-2422-5365

PhD (Medicine), Senior Researcher, Research Laboratory of Molecular Biology, Novokuznetsk State Institute for Further Training of Physicians, Branch Campus of the FSBEI FPE RMACPE MOH.

Novokuznetsk.

Russian Federation

A. L. Khanin

Novokuznetsk State Institute for Further Training of Physicians, Branch Campus of the FSBEI FPE RMACPE MOH

Email: prof.khanin@yandex.ru
ORCID iD: 0000-0001-6857-1879

PhD (Medicine), Professor, Head of the Department of Phthisiopulmonology, Novokuznetsk State Institute for Further Training of Physicians, Branch Campus of the FSBEI FPE RMACPE MOH.

Novokuznetsk.

Russian Federation

References

  1. Патент № 2710266 Российская Федерация, МПК G01N 33/53 (2006.01). Способ прогнозирования летального исхода при клиническом течении коинфекции ВИЧ и туберкулез, сопровождающимся множественной лекарственной устойчивостью Mycobacterium tuberculosis: № 2019130688; заявлено 2019.09.26: опубликовано 2019.12.25 / Мальцева Н.В., Викторова И.Б., Казанцева О.М., Архипова С.В., Ханин А.Л. Патентообладатель: ФГБОУ ДПО РМАНПО Минздрава России. 16 с.
  2. Российское общество фтизиатров. Федеральные клинические рекомендации по диагностике и лечению туберкулеза у больных ВИЧ-инфекцией, 2016 г. М.: РОФ, 2016. URL: http://roftb.ru/net-cat_files/doks2016/rec2016.pdf (11.11.2020)
  3. Abate E., Belayneh M., Gelaw A., Idh J., Getachew A., Alemu S., Diro E., Fikre N., Britton S., Elias D., Aseffa A., Stendahl O., Schon T. The Impact of asymptomatic helminth co-infection in patients with newly diagnosed tuberculosis in North-West Ethiopia. PloS One, 2012, vol. 7, no. 8: e42901. doi: 10.1371/journal.pone.0042901
  4. Becker Y. The changes in the T helper 1 (th1) and T helper 2 (th2) cytokine balance during HIV-1 infection are indicative of an allergic response to viral proteins that may be reversed by Th2 cytokine inhibitors and immune response modifiers — a review and hypothesis. Virus Genes, 2004, vol. 28, no. 1,pp. 5—18. doi: 10.1023/b:viru.0000012260.32578.72
  5. Bei C., Fu M., Zhang Y., Xie H., Yin K., Liu Y., Zhang L., Xie B., Li F., Huang H., Liu Y., Yang L., Zhou J. Mortality and associated factors of patients with extensive drug-resistant tuberculosis: an emerging public health crisis in China. BMC Infect. Dis., 2018, vol. 18, no. 1: 261. doi: 10.1186/s12879-018-3169
  6. Brust J.C.M., Shah N.S., Mlisana K., Moodley P., Allana S., Campbell A., Johnson B.A., Master I., Mthiyane T., Lachman S., Larkan L.M., Ning Y., Malik A., Smith J.P., Gandhi N.R. Improved Survival and cure rates with concurrent treatment for multidrug-resistant Tuberculosis-Human immunodeficiency virus coinfection in South Africa. Clin. Infect. Dis., 2018, vol. 66, no. 8, pp. 1246-1253. doi: 10.1093/cid/ctx1125
  7. Dugas N., Dereuddre-Bosquet N., Goujard C., Dormont D., Tardieu M., Delfraissy J.F. Role of nitric oxide in the promoting effect of HIV type 1 infection and of gp120 envelop glycoprotein on interleukin 4-induced IgE production by normal human mononuclear cells. AIDS Res. Hum. Retroviruses, 2000, vol. 16, pp. 251-258. doi: 10.1089/088922200309340
  8. Ferrazzi M., De Rinaldis M.L., Salotti A., Cirelli A. Serum IgE levels in human immunodeficiency virus (HIV)-1 infected patients: correlation between IgE and CD4+ cells. Eur. Rev. Med. Pharmacol. Sci., 1993, vol. 15, no. 2, pp. 67-70.
  9. Gandhi N.R., Andrews J.R., Brust J.C., Montreuil R., Weissman D., Heo M., Moll A.P., Friedland G.H., Shah N.S. Risk factors for mortality among MDR- and XDR-TB patients in a high HIV prevalence setting. Int. J. Tuberc. Lung Dis., 2012, vol. 16, no. 1, pp. 90-97. doi: 10.5588/ijtld.11.0153
  10. Israeеl-biet D., Labrousse F., Tourani J.-M., Sors H., Andrieu J.-M., Even P. Elevation of IgE in HIV-infected subjects: a marker of poor prognosis. J. Allergy Clin. Immunol., 1992, vol. 89, no. 1, pp. 68-75. doi: 10.1016/s0091-6749(05)80042-9
  11. Khan M.A., Mehreen S., Basit A., Khan R.A., Javaid A. Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at tertiary care hospital in Pakistan. Am.-Euras. J. Toxicol. Sci., 2015, vol. 7, no. 3, pp. 162-172. doi: 10.1155/2019/3569018
  12. Kibret K.T., Moges Y., Memiah P., Biadgilign S. Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies. Infect. Dis. Poverty, 2017, vol. 6, no. 1, pp. 7. doi: 10.1186/s40249-016-0214-x
  13. Koutsonikolis A., Nelson R.P., Fernandez-Caldas E., Brigino E.N., Seleznick M., Good R.A., Lockey R.F. Serum total and specific IgE levels in children infected with human immunodeficiency virus. J. Allergy Clin. Immunol., 1996, no. 97, pp. 692-697. doi: 10.1016/s0091-6749
  14. Kwak N., Kim H., Yoo C., Kim Y.W., Han S.K., Yim J. Changes in treatment outcomes of multidrug-resistant tuberculosis. Int. J. Tuberc. Lung Dis., 2015, vol. 19, no. 5, pp. 525-530. doi: 10.5588/ijtld.14.0739
  15. Kwan C.K., Ernst J.D. HIV and tuberculosis: a deadly human syndemic. Clin. Microbiol. Rev., 2011, vol. 24, no. 2, pp. 351-376. doi: 10.1128/CMR.00042-10
  16. Kwon Y., Kim Y., Suh G., Chung M., Kim H., Kwon O., Choi Y., Kim K., Kim J., Shim Y., Koh W. Treatment outcomes for HIV-uninfected patients with multidrug-resistant and extensively drug-resistant tuberculosis. Clin. Infect. Dis., 2008, vol. 47, no. 4, pp. 496-502. doi: 10.1086/590005
  17. Miguez-Burbano M.J., Shor-Posner G., Fletcher M.A., Lu Y., Moreno J.N., Carcamo C., Page B., Quesada J., Sauberlich H., Baum M.K. Immunoglobulin E levels in relationship to HIV-1 disease, route of infection, and vitamin E status. Allergy, 1995, vol. 50, no. 2, pp. 157-161. doi: 10.1111/j.1398-9995.1995.tb05073.x
  18. Mollel E.W., Chilongola J.O. Predictors for mortality among multidrug-resistant tuberculosis patients in Tanzania. J. Trop. Med., 2017: 9241238. doi: 10.1155/2017/9241238
  19. Pathmanathan I., Dokubo E.K., Shiraishi R.W., Agolory S.G., Auld A.F., Onotu D., Odafe S., Dalhatu I., Abiri O., Debem H.C., Bashorun A., Ellerbrock T. Incidence and predictors of tuberculosis among HIV-infected adults after initiation of antiretroviral therapy in Nigeria, 2004—2012. PLoS One, 2017, vol. 12, no. 3: e0173309. doi: 10.1371/journal.pone.0173309
  20. Schnippel K., Shearer K., Evans D., Berhanu R., Dlamini S., Ndjeka N. Predictors of mortality and treatment success during treatment for rifampicin-resistant tuberculosis within the South African National TB Programme, 2009 to 2011: a cohort analysis of the national case register. Int. J. Infect. Dis., 2015, no. 39, pp. 89-94. doi: 10.1016/j.ijid.2015.09.002
  21. Secord E.A., Kleiner G.I., Auci D.L., Smith-Norowitz T., Chice S., Finkielstein A., Nowakowski M., Fikrig S., Durkin H.G. IgE against HIV proteins in clinically healthy children with HIV disease. J. Allergy Clin. Immunol., 1996, no. 98, pp. 979-984. doi: 10.1016/s0091-6749(96)80015-7
  22. Seroogy C.M., Wara D.W., Bluth M.H., Dorenbaum A., White C., Durkin H.G., Elder M.E. Cytokine profile of a long-term pediatric HIV survivor with hyper-IgE syndrome and a normal CD4 T-cell count. J. Allergy Clin. Immunol., 1999, vol. 104, no. 5, pp. 1045-1051. doi: 10.1016/s0091-6749(99)70087-4
  23. Sharma S.K., Soneja M., Prasad K.T., Ranjan S. Clinical profile & predictors of poor outcome of adult HIV-tuberculosis patients in a tertiary care centre in North India. Indian J. Med. Res., 2014, vol. 139, no. 1, pp. 154-160.
  24. Tang S., Tan S., Yao L., Li F., Li L., Guo X., Liu Y., Hao X., Li Y., Ding X., Zhang Z., Tong L., Huang J. Risk factors for poor treatment outcomes in patients with MDR-TB and XDR-TB in China: retrospective multi-center investigation. PLoS One, 2013, vol. 8, no. 12, pp. 1-8. doi: 10.1371/journal.pone.0082943
  25. Vigano A., Principi N., Crupi L., Onorato J., Vincenzo Z.G., Salvaggio A. Elevation of IgE in HIV-infected children and its correlation with the progression of disease. J. Allergy Clin. Immunol., 1995, vol. 95, no. 2, pp. 627- 634. doi: 10.1016/s0091-6749(95)70326-8
  26. Vijay S., Kumar P., Chauhan L.S., Rao S.V., Vaidyanathan P. Treatment outcome and mortality at one and half year follow-up of HIV infected TB patients under TB control programme in a district of South India. PLoS One, 2011, vol. 6, no. 7: e21008. doi: 10.1371/journal.pone. 0021008
  27. Zhang G., Gong Y., Wang Q., Deng L., Zhang S., Liao Q., Yu G., Wang K., Wang J., Ye S., Liu Z. Outcomes and factors associated with survival of patients with HIV/AIDS initiating antiretroviral treatment in Liangshan prefecture, southwest of China: a retrospective cohort study from 2005 to 2013. Medicine (Baltimore), 2016, vol. 95, no. 27: e3969. doi: 10.1097/MD.0000000000003969

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2020 Mal’tseva N.V., Victorova I.B., Kazantseva O.M., Arkhipova S.V., Khanin A.L.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 64788 от 02.02.2016.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies