title: Effects of antiretroviral therapy on immune function of HIV-infected adults with pulmonary tuberculosis and CD4+ >350 cells/mm3.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV)-tuberculosis coinfection is associated with heightened immune activation, viral replication, and T cell dysfunction. We compared changes in T cell activation and function between patients receiving concurrent treatment for HIV-tuberculosis coinfection and those receiving treatment for tuberculosis alone.
  
  
  METHODS
  HIV-infected adults with tuberculosis and CD4(+) T cell counts >350 cells/mm(3) were randomized to receive tuberculosis treatment alone (control arm; n = 36) or 6 months of antiretroviral therapy (ART) concurrent with tuberculosis treatment (intervention arm; n = 38). HIV viral load, T cell subsets, T cell activation, and cytokine production were measured at enrollment and every 3 months for 12 months.
  
  
  RESULTS
  Differences in absolute CD4(+) and CD8(+) T cell counts were not observed between arms. Viral load was reduced while participants received ART; control patients maintained viral load at baseline levels. Both arms had significant reductions in T cell expression of CD38 and HLA-DR. Interferon-γ production in response to mitogen increased significantly in the intervention arm.
  
  
  CONCLUSIONS
  In HIV-infected adults with tuberculosis and CD4(+) T cell counts >350 cells/mm(3), both tuberculosis treatment and concurrent HIV-tuberculosis treatment reduce T cell activation and stabilize T cell counts. Concurrent ART with tuberculosis treatment does not provide additional, sustained reductions in T cell activation among individuals with preserved immunologic function.
authors.affiliation: Division of Pediatric Infectious Disease, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. clancioni1@aol.com
authors.forename: Christina L
authors.initials: CL
authors.lastname: Lancioni
authors.forename: C Scott
authors.initials: CS
authors.lastname: Mahan
authors.forename: Denise F
authors.initials: DF
authors.lastname: Johnson
authors.forename: Maria
authors.initials: M
authors.lastname: Walusimbi
authors.forename: Keith A
authors.initials: KA
authors.lastname: Chervenak
authors.forename: Sophie
authors.initials: S
authors.lastname: Nalukwago
authors.forename: Edwin
authors.initials: E
authors.lastname: Charlebois
authors.forename: Diane
authors.initials: D
authors.lastname: Havlir
authors.forename: Harriet
authors.initials: H
authors.lastname: Mayanja-Kizza
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Whalen
authors.forename: W Henry
authors.initials: WH
authors.lastname: Boom
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D016207:Cytokines / Q000378:metabolism; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016176:T-Lymphocyte Subsets / Q000276:immunology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D016207:Cytokines