South Clin Ist Euras. 2023; 34(4): 330-334 | DOI: 10.14744/scie.2023.53189

A Marker for Progression of Latent Tuberculosis Infection to Active Tuberculosis Infection in HIV Positive Individuals: CD4/CD8 Ratio

Bülent Kaya¹, Recep Demirhan^2
1Infectious Diseases and Clinical Microbiology Clinic, Kartal Dr. Lütfi Kýrdar City Hospital, Ýstanbul, Türkiye
²Thoracic Surgery Clinic, Kartal Dr. Lütfi Kýrdar City Hospital, Ýstanbul, Türkiye

INTRODUCTION: We aimed to determine the utility of CD4 T lymphocyte counts and percentages and CD4/CD8 ratios as markers for the progression of latent tuberculosis infection (LTBI) to active tuberculosis (TB) infection in HIV-positive patients followed in the Acquired Immunodeficiency Virus (HIV) Polyclinic of our hospital.
METHODS: The files of 530 HIV-positive patients were retrospectively analyzed. “Tuberculin skin test” (TST) was applied after the anti-HIV test was positive. Asymptomatic patients with a TST ≤5 mm were considered TB negative, patients with a TST ≤5 mm were considered LTBI, and all symptomatic patients (fever, cough, night sweats, weight loss) regardless of TST result were considered as active TB infection. CD4 counts and percentages and CD4/CD8 ratios were calculated and the relationship between LTBI and active TB infection was evaluated using Mann-Whitney U test and independent sample t-test.
RESULTS: During the specified period, 530 patients were admitted to the HIV Outpatient Clinic. There were 43 (8.11%) patients in the LTBI group, of whom 4 (9.3%) were female and 39 (90.7%) were male. CD4 was <200 mm³ in 7 (16.3%) patients and >200 mm³ in 36 (83.7%) patients. The mean CD4/CD8 ratio was 0.55 (0.08-1.45). 21 (3.96%) patients had symptoms of fever, cough, night sweats and weight loss and were diagnosed with active TB infection. Among these patients, 1 (4.8%) was female and 20 (95.2%) were male. CD4 was <200 mm³ in 5 (23.8%) patients and >200 mm³ in 16 (76.2%) patients. The mean CD4/CD8 ratio was 0.38 (0.07-1.8). The difference in CD4 counts between patients with LTBI and active TB infection was not significant, but the difference in CD4/CD8 ratio was significant (p<0.05).
DISCUSSION AND CONCLUSION: Immune dysfunction that occurs in HIV and TB co-infection facilitates the activation of LTBI. While CD4 counts and CD4 percentages were not significant as risk markers, CD4/CD8 ratio was found as significant.

Keywords: HIV, LTBI, Active TB Infection, CD4/CD8 Ratio

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HIV Pozitif Bireylerde Latent Tüberküloz Enfeksiyonunun Aktif Tüberküloz Enfeksiyonuna Ýlerlemesinde Bir Belirteç: CD4/CD8 Oraný

Bülent Kaya¹, Recep Demirhan^2
1Kartal Dr. Lütfi Kýrdar Þehir Hastanesi, Enfeksiyon Hastalýklarý ve Klinik Mikrobiyoloji Kliniði, Ýstanbul, Türkiye
²Kartal Dr. Lütfi Kýrdar Þehir Hastanesi, Göðüs Cerrahisi Kliniði, Ýstanbul, Türkiye

GÝRÝÞ ve AMAÇ: Hastanemizin Edinsel Ýmmunyetersizlik Virüsü (HIV) Polikliniði’nde takip edilen HIV pozitif hastalardaki latent tüberküloz enfeksiyonu’nun (LTBE) aktif tüberküloz (TB) enfeksiyonuna ilerlemesinde CD4 T lenfosit sayýlarý ve yüzdeleri ile CD4/CD8 oranlarýnýn bir belirteç olarak kullanýlabilirliklerini öðrenmeyi amaçladýk.
YÖNTEM ve GEREÇLER: 530 HIV pozitif hastanýn dosyalarý retrospektif olarak incelendi. Hastalarýn anti-HIV testi pozitif geldikten sonra “tüberkülin deri testi” (TDT) uygulandý. TDT ≤5 mm olan asemptomatik hastalar TB negatif, >5 mm olan hastalar LTBE, TDT sonucundan baðýmsýz olarak tüm semptomatik (ateþ, öksürük, gece terlemesi, kilo kaybý) hastalar aktif TB enfeksiyonu olarak kabul edildi. CD4 sayýlarý ve yüzdeleri ile CD4/CD8 oranlarý hesaplanýp, bunlarla LTBE ve aktif TB enfeksiyonu arasýndaki iliþki Mann-Whitney U testi ve baðýmsýz örneklem t-testi uygulanarak deðerlendirildi.
BULGULAR: Belirtilen dönemde HIV Polikliniði’ne 530 hasta baþvurdu. LTBE grubunda 43 (%8.11) hasta vardý, bunlarýn 4’ü (%9.3) kadýn, 39’u (%90.7) erkekti. Yedi (%16.3) hastada CD4 <200 mm³ iken, 36 (%83.7) hastada >200 mm³’tü. Ortalama CD4/CD8 oraný 0.55 (0.08-1.45) olarak bulundu. 21 (%3.96) hastada ateþ, öksürük, gece terlemesi ve kilo kaybý semptomlarý vardý ve aktif TB enfeksiyonu tanýsý aldý. Bu hastalardan 1’i (%4.8) kadýn, 20’si (%95.2) erkek idi. Beþ (%23.8) hastada CD4 <200 mm³ iken 16 (%76.2) hastada >200 mm³ idi. Ortalama CD4/CD8 oraný 0.38 (0.07-1.8) olarak saptandý. LTBE ile aktif TB enfeksiyonu arasýndaki CD4 sayýlarý arasýndaki fark anlamlý deðildi fakat CD4/CD8 oranlarý arasýndaki fark anlamlý bulundu (p<0.05).
TARTIÞMA ve SONUÇ: HIV ve TB ko-enfeksiyonunda oluþan immün bozukluk LTBE’nin aktifleþmesini kolaylaþtýrýr. Risk belirteci olarak CD4 sayýlarý ve CD4 yüzdeleri anlamlý deðilken, CD4/CD8 oraný anlamlý bulundu.

Anahtar Kelimeler: HIV, LTBE, Aktif TB Enfeksiyonu, CD4/CD8 Oraný

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