Role of tuberculin testing in predicting immune reconstitution response after antiretroviral therapy in patients with HIV–TB co infection

Dr Prachee Makashir; Dr Parinita Shinde

Volume : V, Issue : I, January - 2015

Role of tuberculin testing in predicting immune reconstitution response after antiretroviral therapy in patients with HIV–TB co infection

Dr Prachee Makashir, Dr Parinita Shinde

Abstract :

Background – Suppression of HIV replication by HAART often restores protective pathogen specific immune responses, but in some patients the restored immune response causes various pathological manifestations termed as immune reconstitution. Objective– To review clinical profile of HIV patients exhibiting immune reconstitution after starting HAART and to assess whether restoration of tuberculin skin testing can alert us from such response. Material and methods– This prospective study over 18 months, included 40 HIV positive patients with tuberculosis receiving antituberculous treatment and who were subsequently started on HAART. Tuberculin testing was performed on all the patients before ART. They were followed up monthly. Patients who showed symptomatic worsening, deterioration of laboratory/radiological investigations but improving CD4 count were kept under observation. After extensive work up to rule out causes such as treatment failure, other HIV related opportunistic infections etc, patients were defined to have immune reconstitution. Tuberculin testing was repeated in such patients at the time of worsening and in other patients monthly for 6 months. Observation and results– 5 out of 40 patients showed immune reconstitution as per the definition. Clinical profile, base line CD4 count, radiological and laboratory parameters of such patients were studied. Tuberculin testing turned to positive in all 5 patients. It remained negative in all other patients. Mean baseline CD4 count of patients without immune reconstitution was 184/cmm, and with immune reconstitution was 58.6/cmm. This difference was clinically significant. Mean time interval to develop immune reconstitution was 31 days. Conclusion and summary– immune reconstitution was seen on 5 put of 40 patients (12.5%). These patients had low mean CD4 count at the baseline. All patients (100%) exhibited restoration of tuberculin testing. This restoration can be utilized as a predictor of immune reconstitution, an atypical but clinically important phenomenon.