Monocyte immune activation and HIV/AIDS disease progression among patients co infected with TB/HIV
Introduction: Tuberculosis is an infectious disease caused by the bacillus MTB and is the second leading cause of death from an infectious disease worldwide. Immune activation of T cells and monocytes is a potent mechanism in the immune response tocontain pr eradicate MTB. The advent of HIV has exacerbated the threat of death due to TB. Among TB patients coinfected with HIV there is a tendency of rapid progression towards AIDS. The immune activation of the T cells and monocytes involved in the cell-mediated immune response to TB may playa role in this rapid progression. Objective: This aim of this study was to determine the relationship between the level of monocyte immune activation and the progression towards HIV I AIDS among patients co-infected with TBIHIV. Methodology: A laboratory based cross sectional study was employed on 101 TB patients from MDH, among whom 33 TBIHIV co-infected patients were selected to provide core data for the study. Their blood was drawn and CD4 count determined, PBMCs isolated, and T lymphocyte and monocyte immune activation determined by flow cytometry. The results for the TB/HIV coinfected group stratified by CD4 count. Spearman's bivariate correlation was used to determine the strength of association between T cell and monocyte immune activation. Results: The highest level of immune activation was seen among the subjects with CD4 count <200 cells/ul and the lowest among those with CD4 count ~400 cells/ul. The strongest significant positive correlation between T cell immune activation and TB antigen-specific immune activation was in the CD4 count <200 cells/ul category, while the opposite was true for the CD4 count ~400 cells/ul category. Also, the only significant correlation between TB antigenspecific immune activation and the level of immune modulation was found among the CD4 count <200 cells/ul category. Conclusion: The results give a strong basis to support the hypothesis that MTB induces monocyte immune activation, which affect CD4+ T lymphocytes and may contribute to more rapid progression to AIDS disease among TB/HIV co-infected patients. These data highlight the need to emphatically warn TB+IHIV - patients to avoid acquiring HIV and to consider periodical evaluation of the immune activation levels among TB/HIV co-infected patients for indicators of good response to disease management.