title: Age, sex, and nutritional status modify the CD4+ T-cell recovery rate in HIV-tuberculosis co-infected patients on combination antiretroviral therapy.
abstract: BACKGROUND
  Baseline age and combination antiretroviral therapy (cART) were examined as determinants of CD4+ T-cell recovery during 6 months of tuberculosis (TB) therapy with/without cART. It was determined whether this association was modified by patient sex and nutritional status.
  
  
  METHODS
  This longitudinal analysis included 208 immune-competent, non-pregnant, ART-naive HIV-positive patients from Uganda with a first episode of pulmonary TB. CD4+ T-cell counts were measured using flow cytometry. Age was defined as ≤24, 25-29, 30-34, and 35-39 vs. ≥40 years. Nutritional status was defined as normal (>18.5kg/m(2)) vs. underweight (≤18.5kg/m(2)) using the body mass index (BMI). Multivariate random effects linear mixed models were fitted to estimate differences in CD4+ T-cell recovery in relation to specified determinants.
  
  
  RESULTS
  cART was associated with a monthly rise of 15.7 cells/μl (p<0.001). Overall, age was not associated with CD4+ T-cell recovery during TB therapy (p = 0.655). However, among patients on cART, the age-associated CD4+ T-cell recovery rate varied by sex and nutritional status, such that age <40 vs. ≥40 years predicted superior absolute CD4+ T-cell recovery among females (p=0.006) and among patients with a BMI ≥18.5kg/m(2) (p<0.001).
  
  
  CONCLUSIONS
  TB-infected HIV-positive patients aged ≥40 years have a slower rate of immune restoration given cART, particularly if BMI is >18.5kg/m(2) or they are female. These patients may benefit from increased monitoring and nutritional support during cART.
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA 30602, USA. Electronic address: aezeamam@uga.edu.
authors.forename: Amara E
authors.initials: AE
authors.lastname: Ezeamama
authors.affiliation: Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda; Uganda-Case Western Reserve Research Collaboration, Kampala, Uganda.
authors.forename: Ezekiel
authors.initials: E
authors.lastname: Mupere
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA 30602, USA.
authors.forename: James
authors.initials: J
authors.lastname: Oloya
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA 30602, USA.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Martinez
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA 30602, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Kakaire
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA 30602, USA.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Yin
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA 30602, USA; School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Sekandi
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA 30602, USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Whalen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D060085:Coinfection / Q000276:immunology*; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D012737:Sex Factors; D014397:Tuberculosis, Pulmonary / Q000150:complications*; D014454:Uganda; D055815:Young Adult
keywords: Aging; HAART; HIV; Immune-competence; Nutritional status