CD4 and Its Relevance to Advanced Glycation End Products in Tuberculosis Patients with Co-morbidity Diabetes

A retrospective study of tuberculosis prevalence and associated factors among HIV-positive key populations in Nigeria

HIV is a major risk factor for active Tuberculosis (TB.) This raises patients' risk of original infection, reinfection, and TB reactivation. Providing healthcare to KPLHIV in developing countries requires TB prevalence research. This study aims to determine the prevalence of TB and HIV co-infection and associated factors among KPLHIV. This is a retrospective cross-sectional study among KP's living with HIV enrolled on care in One Stop Shop (OSS) of Heartland Alliance Ltd/GTE across six states in Nigeria. Data were analysed using IBM SPSS version 25.0. Secondary data analysis of client's records from the RADET files of the KPCARE 1 project from 6 states was conducted. Means with standard deviations were computed for continuous variables like age, and frequency tables were generated for categorical variables. Chi-square tests and t-tests were used for the bivariate analysis of variables. All tests were done at a 5% level of statistical significance (p = 0.05).TB prevalence was 19.1% among KP's living with HIV, with variations observed in age groups, geographic locations, target populations, marital status, educational backgrounds, clinical characteristics, and antiretroviral therapy (ART) history. KPs aged 51 and above exhibited the highest TB prevalence (21.0%), while those aged below 20 years had the lowest (18.2%). Jigawa KPs recorded the highest TB prevalence (38.4%), and Niger had the least (13.3%). TB was more prevalent among People who inject drugs (20.3%), divorced (32.3%), and those who attained Qur'anic education (29.7%). KPs who had to restart ART exhibited the highest TB prevalence (22.0%), whereas those who experienced Interruption in treatment (IIT) reported the lowest at 10.0%. Immune-suppressed KPs (CD4 counts < 200 cells/m3) had a higher TB prevalence of 26.6%. TB prevalence among KPs living with HIV varies greatly, underlining the need for targeted treatments, especially for high-risk categories, to improve HIV treatment outcomes and reduce TB prevalence.

Impact of Diabetes Mellitus on the Immunity of Tuberculosis Patients: A Retrospective, Cross-Sectional Study

Background

Tuberculosis (TB) is an infectious disease that poses a significant health threat and is one of the leading causes of death worldwide. Diabetes mellitus (DM) has high morbidity and mortality rates. Previous studies have reported that comorbidities can influence one another and aggravate immune disorders. A systematic and comprehensive evaluation of the immune status of patients with TB and DM (TB-DM) is helpful for early clinical immune intervention and for promoting the recovery of patients with TB-DM.

Methods

This study included 159 patients with TB without DM (TB-NDM) and 168 patients with TB-DM. Interferon-γ (IFN-γ) release assays (IGRAs) and TB-specific antibodies against 38kD+16kD proteins were used to detect humoral and cellular immune responses. Flow cytometry was used to analyze the absolute counts of the lymphocyte subsets.

Results

There was no significant difference in the positive rate of enzyme-linked immunospot (ELISPOT) assays, enzyme linked immunosorbent assay (ELISA), and 38kD+16kD antibodies between the TB-DM and TB-NDM groups. Pulmonary lobe lesion and cavity formation rates were significantly higher in patients with TB-DM with poor glycemic control than patients with TB-NDM and TB-DM with normal glycemic control. The absolute counts of T lymphocytes, CD8+ T lymphocytes, and B lymphocytes in patients with TB-DM were markedly lower than those in patients with TB-NDM. The absolute counts of T lymphocytes and CD8+ T lymphocytes in patients with TB-DM and hyperglycemia were lower than those in patients with euglycemia. Linear regression analysis revealed that the absolute counts of total T lymphocytes, CD8+ T lymphocytes, and NK cells in patients with TB-DM significantly decreased with increasing fasting blood glucose (FBG) levels.

Conclusion

Hyperglycemia is a risk factor for pulmonary cavity formation and lobe lesions in patients with TB-DM and suppresses the absolute counts of total T lymphocytes, CD8+ T lymphocytes, and NK cells in patients with TB-DM. The potential mechanism may involve the downregulation of innate and adaptive immune responses.

The association of glycemic level and prevalence of tuberculosis: a meta-analysis

BACKGROUND

Diabetes is a well-known risk factor for tuberculosis and poorly glycemic control may increase the risk of tuberculosis. We performed a meta-analysis to explore the association of glycemic control in diabetic patients and their tuberculosis prevalence.

METHODS

We included observational studies that investigated the prevalence of tuberculosis associated with glycemic control. The markers of glycated hemoglobin A1c (HbA1c) and fasting plasma glucose were used to evaluate the exposure of interest in the study. We searched related articles in PubMed, EMBASE and Web of Science through 14 December 2019. The Newcastle-Ottawa scale was used to assess the risk of bias of included studies.

RESULTS

Seventeen studies (four cohort studies, five case-control studies and eight cross-sectional studies) were included, involving 1,027,074 participants. The meta-analysis found the pooled odds ratio of prevalent tuberculosis increased a 2.05-fold (95%CI: 1.65, 2.55) for the patients with HbA1c ≥7.0% compared to those with HbA1c concentration < 7.0%. Furthermore, we found the mean of HbA1c was higher in the diabetes mellitus with tuberculosis group than the diabetes-only group (P = 0.002). In the sensitivity analysis, the finding remains consistent.

CONCLUSION

Our study provides the evidence that poorly controlled diabetes in diabetics may be associated with increased prevalence of tuberculosis. More efforts should focus on screening tuberculosis in uncontrolled diabetes.