Lipids as Indirect Biomarkers of Pulmonary Tuberculosis in Patients with and Without Hiv Infection in Addis Ababa, Ethiopia

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Addis Ababa University


Background: - Even though some studies have shown that lipids could be indirect markers of pulmonary tuberculosis (TB), there is no sufficient data from Ethiopia which characterize the level of these markers during TB disease and infection. Nonetheless, the effect of HIV co-infection and its treatment on the level of these makers is not well investigated. Objective: - to determine whether lipids are indirect biomarkers of pulmonary TB in pts with or with out HIV infection. Methods: - fasting plasma samples collected from 159 untreated adults visiting various health institutions in Addis Ababa (44 HIV+/TB+, 49 HIV-/TB+, 17 HIV+/TST+, 24 HIV-/TST+ and 25 HIV-/TST-) at baseline, from 88 (30 HIV+/TB+, 47 HIV-/TB+ and 11 HIV+/TST+) groups after 6 month of ATT and ART and from 31 (20 HIV+/TB+ and 11 HIV+/TST+) groups after 18 months of ART and stored for five years at -80 0C until analyzed for total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) using Cobas Integra 400 plus. We used stata version 11 for statistical analysis. Results: -at baseline, mean level of TC, LDL-C and HDL-C were significantly lower in HIV-TB+, HIV+TB+ and HIV+TST+ as compared to HIV-TST+ and HIV-TST-. TG was also significantly lower in HIV+/TB+, HIV-TB+ and HIV+/TST+ than in HIV-TST-. Patients with HIV-/TB+ were also significantly different from HIV-/TST+ groups for TG levels. On the other hand HIV-TB+, HIV+TB+ and HIV+TST+ did not differ significantly from each other for most lipid profiles except for HDL-C that was markedly lower in HIV+/TB+ than HIV-/TB+ and HIV+/TST+ groups. After 6 month of ATT for HIV-/TB+ groups, significant increases were observed in TC, LDL-C and HDL-C. Proportion of patients with abnormal high TC, TG and LDL-C after ATT was very few (≈ 4%). For HIV+/TB+ patients, After 4 months of ART and 6 month of ATT, significant increases were observed in TC, TG and HDL-C levels. At 18 months, the proportion of patients with TC levels ≥ 200 mg/dl had increased significantly, from 0 to 20 % and TG levels > 150 mg/dl from 0 to 30 %. However, the proportion of patients with HDL-C levels < 40 mg/dl decreased significantly, from 95 % to 50 %. For HIV+/TST+ patients, After 6 months of ART, no significant change in all lipid levels. However, after 18 months of treatment, TC levels significantly increased by a mean of 61 mg/dl and LDL-C increased by 37 mg/dl Conclusion and recommendations: In addition to cardiovascular risk prediction, if confirmed in further studies with larger sample size and combined with other prognostic clinical and laboratory markers, measurement of plasma lipids may allow clinicians and investigators to target patients with pulmonary TB in whom microscopy is most likely to yield a pathogen. Key words: TB, TB/HIV co-infection, biomarker, lipids, ATT, ART



TB, TB/HIV co-infection, Biomarker, Lipids