Antitubercular therapy decreases nitric oxide production in HIV/TB coinfected patients.
BACKGROUND
Nitric oxide (NO) production is increased among patients with human immunodeficiency virus (HIV) infection and also those with tuberculosis (TB). In this study we sought to determine if there was increased NO production among patients with HIV/TB coinfection and the effect of four weeks chemotherapy on this level.


METHODS
19 patients with HIV/TB coinfection were studied. They were treated with standard four drug antitubercular therapy and sampled at baseline and four weeks. 20 patients with HIV infection but no opportunistic infections were disease controls and 20 individuals as healthy controls. Nitrite and citrulline, surrogate markers for NO, were measured it spectrophotometrically.


RESULTS
Mean age of HIV/TB patients was 28.4+6.8 years and CD4 count was 116+36.6/mm3. Mean nitrite level among HIV/TB coinfected was 207.6+48.8 nmol/ml. This was significantly higher than 99.7+26.5 nmol/ml, the value for HIV infected without opportunistic infections and 46.4+16.2 nmol/ml, the value for healthy controls (p value <0.01). Level of HIV/TB coinfected declined to 144.5+ 34.4 nmol/ml at four weeks of therapy (p value < 0.05). Mean citrulline among HIV/TB coinfected was 1446.8+468.8 nmol/ml. This was significantly higher than 880.8+ 434.8 nmol/ml, the value for HIV infected without opportunistic infections and 486.6+212.5 nmol/ml, the value for healthy controls (p value <0.01). Levels of HIV/TB infected declined to 1116.2+388.6 nmol/ml at four weeks of therapy (p value <0.05).


CONCLUSIONS
NO production is elevated among patients with HIV infection, especially so among HIV/TB coinfected, but declines significantly following 4 weeks of antitubercular therapy.
Wanchu
Ajay
A
Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, India. awanchu@glide.net.in
Bhatnagar
Archana
A
Khullar
Madhu
M
Sud
Archana
A
Bambery
Pradeep
P
Singh
Surjit
S
D000328:Adult; D000904:Antibiotics, Antitubercular / Q000494:pharmacology / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism; D002956:Citrulline / Q000097:blood; D004334:Drug Administration Schedule; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism*; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009161:Mycobacterium / Q000187:drug effects; D009569:Nitric Oxide / Q000037:antagonists & inhibitors* / Q000096:biosynthesis*; D009573:Nitrites / Q000097:blood; D011718:Pyrazinamide / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D016176:T-Lymphocyte Subsets / Q000378:metabolism; D014376:Tuberculosis / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism*
D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D015415:Biomarkers; D004791:Enzyme Inhibitors; D009573:Nitrites; D002956:Citrulline; D011718:Pyrazinamide; D009569:Nitric Oxide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin