Plasma Levels of Neopterin and C-Reactive Protein (CRP) in Tuberculosis (TB) with and without HIV Coinfection in Relation to CD4 Cell Count
While the risk of TB is elevated in HIV-positive subjects with low CD4 cell counts, TB may in itself be associated with CD4 lymphocytopenia. We investigated markers of immune activation (neopterin) and inflammation (CRP) in TB patients with and without HIV coinfection and their association with CD4...
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| Veröffentlicht in: | PloS one 2015, Vol.10 (12), p.e0144292-e0144292 |
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| creator | Skogmar, Sten Schön, Thomas Balcha, Taye Tolera Sturegård, Erik Jansson, Marianne Björkman, Per |
| description | While the risk of TB is elevated in HIV-positive subjects with low CD4 cell counts, TB may in itself be associated with CD4 lymphocytopenia. We investigated markers of immune activation (neopterin) and inflammation (CRP) in TB patients with and without HIV coinfection and their association with CD4 cell levels, and determined their predictive capacity as alternative markers of advanced immunosuppression.
Participants selected from a cohort of adults with TB at Ethiopian health centers (195 HIV+/TB+, 170 HIV-/TB+) and 31 controls were tested for plasma levels of neopterin and CRP. Baseline levels of neopterin and CRP were correlated to CD4 cell count before and after anti-TB treatment (ATT). The performance to predict CD4 cell strata for both markers were investigated using receiver operating curves.
Levels of both biomarkers were elevated in TB patients (neopterin: HIV+/TB+ 54 nmol/l, HIV-/TB+ 23 nmol/l, controls 3.8 nmol/l; CRP: HIV+/TB+ 36 μg/ml, HIV-/TB+ 33 μg/ml, controls 0.5 μg/ml). Neopterin levels were inversely correlated (-0.53, p |
| doi_str_mv | 10.1371/journal.pone.0144292 |
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Participants selected from a cohort of adults with TB at Ethiopian health centers (195 HIV+/TB+, 170 HIV-/TB+) and 31 controls were tested for plasma levels of neopterin and CRP. Baseline levels of neopterin and CRP were correlated to CD4 cell count before and after anti-TB treatment (ATT). The performance to predict CD4 cell strata for both markers were investigated using receiver operating curves.
Levels of both biomarkers were elevated in TB patients (neopterin: HIV+/TB+ 54 nmol/l, HIV-/TB+ 23 nmol/l, controls 3.8 nmol/l; CRP: HIV+/TB+ 36 μg/ml, HIV-/TB+ 33 μg/ml, controls 0.5 μg/ml). Neopterin levels were inversely correlated (-0.53, p<0.001) to CD4 cell count, whereas this correlation was weaker for CRP (-0.25, p<0.001). Neither of the markers had adequate predictive value for identification of subjects with CD4 cell count <100 cells/mm3 (area under the curve [AUC] 0.64 for neopterin, AUC 0.59 for CRP).
Neopterin levels were high in adults with TB, both with and without HIV coinfection, with inverse correlation to CD4 cell count. This suggests that immune activation may be involved in TB-related CD4 lymphocytopenia. However, neither neopterin nor CRP showed promise as alternative tests for immunosuppression in patients coinfected with HIV and TB.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0144292</identifier><identifier>PMID: 26630153</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Activation ; Adult ; Adults ; Antitubercular Agents - therapeutic use ; Biomarkers ; Biomarkers - blood ; Biomarkers - metabolism ; C-reactive protein ; C-Reactive Protein - metabolism ; Care and treatment ; Case-Control Studies ; CD4 antigen ; CD4 Lymphocyte Count - methods ; CD4-Positive T-Lymphocytes - metabolism ; Cell activation ; Clinical Medicine ; Coinfection - blood ; Coinfection - metabolism ; Coinfection - microbiology ; Coinfection - virology ; Correlation ; Female ; Follow-Up Studies ; Health aspects ; Health risks ; HIV ; HIV infections ; HIV Infections - blood ; HIV Infections - metabolism ; HIV patients ; Hospitals ; Human immunodeficiency virus ; Humans ; Immune response ; Immunosuppression ; Immunotherapy ; Infections ; Infectious diseases ; Infectious Medicine ; Infektionsmedicin ; Klinisk medicin ; Laboratories ; Lymphopenia ; Lymphopenia - blood ; Lymphopenia - metabolism ; Lymphopenia - microbiology ; Lymphopenia - virology ; Male ; Medical and Health Sciences ; Medical tests ; Medicin och hälsovetenskap ; Neopterin ; Neopterin - blood ; Patients ; Plasma ; Plasma levels ; Prospective Studies ; Retrospective Studies ; Risk factors ; Science ; Tuberculosis ; Tuberculosis - blood ; Tuberculosis - drug therapy ; Tuberculosis - metabolism ; Young Adult</subject><ispartof>PloS one, 2015, Vol.10 (12), p.e0144292-e0144292</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Skogmar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Skogmar et al 2015 Skogmar et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c765t-e30161c0e78c468ddabba5f9a1e31ae28f16302f19e439ab2f5eada3dd5c86883</citedby><cites>FETCH-LOGICAL-c765t-e30161c0e78c468ddabba5f9a1e31ae28f16302f19e439ab2f5eada3dd5c86883</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668010/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668010/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,552,727,780,784,864,885,2102,2928,4024,23866,27923,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26630153$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-123757$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://lup.lub.lu.se/record/8505766$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:132571968$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><contributor>Apetrei, Cristian</contributor><creatorcontrib>Skogmar, Sten</creatorcontrib><creatorcontrib>Schön, Thomas</creatorcontrib><creatorcontrib>Balcha, Taye Tolera</creatorcontrib><creatorcontrib>Sturegård, Erik</creatorcontrib><creatorcontrib>Jansson, Marianne</creatorcontrib><creatorcontrib>Björkman, Per</creatorcontrib><title>Plasma Levels of Neopterin and C-Reactive Protein (CRP) in Tuberculosis (TB) with and without HIV Coinfection in Relation to CD4 Cell Count</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>While the risk of TB is elevated in HIV-positive subjects with low CD4 cell counts, TB may in itself be associated with CD4 lymphocytopenia. We investigated markers of immune activation (neopterin) and inflammation (CRP) in TB patients with and without HIV coinfection and their association with CD4 cell levels, and determined their predictive capacity as alternative markers of advanced immunosuppression.
Participants selected from a cohort of adults with TB at Ethiopian health centers (195 HIV+/TB+, 170 HIV-/TB+) and 31 controls were tested for plasma levels of neopterin and CRP. Baseline levels of neopterin and CRP were correlated to CD4 cell count before and after anti-TB treatment (ATT). The performance to predict CD4 cell strata for both markers were investigated using receiver operating curves.
Levels of both biomarkers were elevated in TB patients (neopterin: HIV+/TB+ 54 nmol/l, HIV-/TB+ 23 nmol/l, controls 3.8 nmol/l; CRP: HIV+/TB+ 36 μg/ml, HIV-/TB+ 33 μg/ml, controls 0.5 μg/ml). Neopterin levels were inversely correlated (-0.53, p<0.001) to CD4 cell count, whereas this correlation was weaker for CRP (-0.25, p<0.001). Neither of the markers had adequate predictive value for identification of subjects with CD4 cell count <100 cells/mm3 (area under the curve [AUC] 0.64 for neopterin, AUC 0.59 for CRP).
Neopterin levels were high in adults with TB, both with and without HIV coinfection, with inverse correlation to CD4 cell count. This suggests that immune activation may be involved in TB-related CD4 lymphocytopenia. However, neither neopterin nor CRP showed promise as alternative tests for immunosuppression in patients coinfected with HIV and TB.</description><subject>Activation</subject><subject>Adult</subject><subject>Adults</subject><subject>Antitubercular Agents - therapeutic use</subject><subject>Biomarkers</subject><subject>Biomarkers - blood</subject><subject>Biomarkers - metabolism</subject><subject>C-reactive protein</subject><subject>C-Reactive Protein - metabolism</subject><subject>Care and treatment</subject><subject>Case-Control Studies</subject><subject>CD4 antigen</subject><subject>CD4 Lymphocyte Count - methods</subject><subject>CD4-Positive T-Lymphocytes - metabolism</subject><subject>Cell activation</subject><subject>Clinical Medicine</subject><subject>Coinfection - blood</subject><subject>Coinfection - metabolism</subject><subject>Coinfection - microbiology</subject><subject>Coinfection - virology</subject><subject>Correlation</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health aspects</subject><subject>Health risks</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - blood</subject><subject>HIV Infections - metabolism</subject><subject>HIV patients</subject><subject>Hospitals</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Immune response</subject><subject>Immunosuppression</subject><subject>Immunotherapy</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Infectious Medicine</subject><subject>Infektionsmedicin</subject><subject>Klinisk medicin</subject><subject>Laboratories</subject><subject>Lymphopenia</subject><subject>Lymphopenia - blood</subject><subject>Lymphopenia - metabolism</subject><subject>Lymphopenia - microbiology</subject><subject>Lymphopenia - virology</subject><subject>Male</subject><subject>Medical and Health Sciences</subject><subject>Medical tests</subject><subject>Medicin och hälsovetenskap</subject><subject>Neopterin</subject><subject>Neopterin - blood</subject><subject>Patients</subject><subject>Plasma</subject><subject>Plasma levels</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Science</subject><subject>Tuberculosis</subject><subject>Tuberculosis - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SWEPUB Linköpings universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Linköpings universitet</collection><collection>SwePub Articles full text</collection><collection>SWEPUB Lunds universitet full text</collection><collection>SWEPUB Lunds universitet</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Skogmar, Sten</au><au>Schön, Thomas</au><au>Balcha, Taye Tolera</au><au>Sturegård, Erik</au><au>Jansson, Marianne</au><au>Björkman, Per</au><au>Apetrei, Cristian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Plasma Levels of Neopterin and C-Reactive Protein (CRP) in Tuberculosis (TB) with and without HIV Coinfection in Relation to CD4 Cell Count</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2015</date><risdate>2015</risdate><volume>10</volume><issue>12</issue><spage>e0144292</spage><epage>e0144292</epage><pages>e0144292-e0144292</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>While the risk of TB is elevated in HIV-positive subjects with low CD4 cell counts, TB may in itself be associated with CD4 lymphocytopenia. We investigated markers of immune activation (neopterin) and inflammation (CRP) in TB patients with and without HIV coinfection and their association with CD4 cell levels, and determined their predictive capacity as alternative markers of advanced immunosuppression.
Participants selected from a cohort of adults with TB at Ethiopian health centers (195 HIV+/TB+, 170 HIV-/TB+) and 31 controls were tested for plasma levels of neopterin and CRP. Baseline levels of neopterin and CRP were correlated to CD4 cell count before and after anti-TB treatment (ATT). The performance to predict CD4 cell strata for both markers were investigated using receiver operating curves.
Levels of both biomarkers were elevated in TB patients (neopterin: HIV+/TB+ 54 nmol/l, HIV-/TB+ 23 nmol/l, controls 3.8 nmol/l; CRP: HIV+/TB+ 36 μg/ml, HIV-/TB+ 33 μg/ml, controls 0.5 μg/ml). Neopterin levels were inversely correlated (-0.53, p<0.001) to CD4 cell count, whereas this correlation was weaker for CRP (-0.25, p<0.001). Neither of the markers had adequate predictive value for identification of subjects with CD4 cell count <100 cells/mm3 (area under the curve [AUC] 0.64 for neopterin, AUC 0.59 for CRP).
Neopterin levels were high in adults with TB, both with and without HIV coinfection, with inverse correlation to CD4 cell count. This suggests that immune activation may be involved in TB-related CD4 lymphocytopenia. However, neither neopterin nor CRP showed promise as alternative tests for immunosuppression in patients coinfected with HIV and TB.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26630153</pmid><doi>10.1371/journal.pone.0144292</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2015, Vol.10 (12), p.e0144292-e0144292 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1738753151 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; SWEPUB Freely available online; Public Library of Science (PLoS) Journals Open Access; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Activation Adult Adults Antitubercular Agents - therapeutic use Biomarkers Biomarkers - blood Biomarkers - metabolism C-reactive protein C-Reactive Protein - metabolism Care and treatment Case-Control Studies CD4 antigen CD4 Lymphocyte Count - methods CD4-Positive T-Lymphocytes - metabolism Cell activation Clinical Medicine Coinfection - blood Coinfection - metabolism Coinfection - microbiology Coinfection - virology Correlation Female Follow-Up Studies Health aspects Health risks HIV HIV infections HIV Infections - blood HIV Infections - metabolism HIV patients Hospitals Human immunodeficiency virus Humans Immune response Immunosuppression Immunotherapy Infections Infectious diseases Infectious Medicine Infektionsmedicin Klinisk medicin Laboratories Lymphopenia Lymphopenia - blood Lymphopenia - metabolism Lymphopenia - microbiology Lymphopenia - virology Male Medical and Health Sciences Medical tests Medicin och hälsovetenskap Neopterin Neopterin - blood Patients Plasma Plasma levels Prospective Studies Retrospective Studies Risk factors Science Tuberculosis Tuberculosis - blood Tuberculosis - drug therapy Tuberculosis - metabolism Young Adult |
| title | Plasma Levels of Neopterin and C-Reactive Protein (CRP) in Tuberculosis (TB) with and without HIV Coinfection in Relation to CD4 Cell Count |
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