Assessment of Total Serum Immunoglobulin Levels and CD4+ T-Lymphocyte Counts in Pulmonary Tuberculosis Patients Co-Infected With HIV in Uyo, Nigeria

Background: Poor disease diagnosis and monitoring, could aid in the progression of Tuberculosis especially in Tuberculosis/HIV co-infected patients.

Aim: This study aimed to evaluate the levels of cellular (CD4+ T-Cell) and humoral (immunoglobulin classes IgA, IgG, IgM) markers associated with PTB and HIV infection in sputum producing patients in Uyo, Southsouth, Nigeria.

Study Design: This was a cross sectional study of patients suspected with PTB and HIV.

Study Location and Duration: The study was conducted at the Tuberculosis and HIV clinics of University of Uyo Teaching Hospital and St. Luke's Hospital all in Uyo, Akwa Ibom State, Nigeria, from October, 2013 to September, 2014.

Methodology: Sputum producing adult patients, 105 (male 48, female 57; age range 18 - >60 years), who were referred to the laboratory for investigation, were recruited for the study. On the spot and overnight sputum samples were collected and analysed using Ziehl Neelsen's technique and fluorescence microscopy. Blood samples were collected by veni-puncture and assayed for HIV status using rapid test kits while CD4+ T-cell counts and total serum immunoglobulin levels were determined by flow cytometry and ELISA techniques, respectively. Subjects were classified into PTB, HIV and PTB/HIV-infected groups.

Results: Mean CD4+ T-cell counts (cells/ul) in the order of PTB/HIV (175.12±85.8)<HIV (311.06±228.6)<PTB (576.31±326.7) were significantly lower than apparently healthy control subjects (1294±334.9) (p<0.05). Mean IgA values (mg/dl) in the order of HIV (208.85±104.9)>PTB/HIV (206.0±71.7) were significantly higher than the control group (126.81±35.5). Mean IgG values (mg/dl) of PTB/HIV (1498.54±35.5) was significantly higher than other patient and control groups (p<0.001). The mean IgM values (mg/dl) of patient groups was significantly higher than those of control (50.00±32.3) (p<0.001). There was a significant moderate negative correlation (r=-0.56) between categorized CD4+ T-cell counts (≤200 cells/µl and >200 cells/µl) and total serum IgG levels in PTB/HIV group. PTB/HIV cases with severe cellular immune suppression had very high IgG levels.

Conclusion: CD4+ T-cell counts and levels of immunoglobulin classes, particularly IgG, were significantly affected in PTB/HIV co-infection. Therefore, these immune markers could be useful in predicting and monitoring disease progression in PTB/HIV coinfected patients.