Dynamics of plasma cytokine levels in patients with advanced HIV infectionand active tuberculosis: implications for early recognition of patients with poor response to anti-tuberculosis treatment
Sm. Hsieh et al., Dynamics of plasma cytokine levels in patients with advanced HIV infectionand active tuberculosis: implications for early recognition of patients with poor response to anti-tuberculosis treatment, AIDS, 13(8), 1999, pp. 935-941
Objective: To examine whether the serial measurement of plasma cytokine lev
els 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 w
ith advanced HIV infection and suspected tuberculosis were enrolled in the
study. Plasma samples were obtained on day 1 (baseline), 3, 7 and 14 of ant
i-tuberculosis treatment and the levels of tumour necrosis factor-alpha (TN
F-alpha) were measured. Patients were classified as either responders or no
n-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 10(6)/l; 12 responders and four non-responders) and 21 HIV-negative patie
nts (16 responders and five non-responders), whose tuberculosis was culture
-proven, were included for analysis. In responders, TNF-alpha levels declin
ed remarkably within the first week of anti-tuberculosis treatment; however
, the decline of TNF-alpha levels in non-responders was significantly less
[the median ratio of TNF-alpha 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 H
IV-negative patients). The lack of a greater than or equal to 50% reduction
in pretreatment TNF-alpha levels during the first week of treatment was st
rongly 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-alpha levels may help to asses
s the response to anti-tuberculosis treatment in AIDS patients, in spite of
very low CD4 cell counts. Failure of TNF-alpha levels to decline by greate
r than or equal to 50 % of pre-treatment levels in the first week of treatm
ent may be an early surrogate marker of a poor response. (C) Lippincott Wil
liams & Wilkins.