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Trop Med Int Health. 2012 Dec;17(12):1527-33. doi: 10.1111/tmi.12001. Epub 2012 Nov 6.

Unrecognised tuberculosis at antiretroviral therapy initiation is associated with lower CD4+ T cell recovery.

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Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda  Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands  Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands  Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.



To investigate whether an unrecognised diagnosis of tuberculosis (TB) at the start of antiretroviral therapy (ART) influences subsequent CD4+ T cell (CD4) count recovery in an urban HIV clinic in Uganda.


In a retrospective cohort study, a multivariable polynomial mixed effects model was used to estimate CD4 recovery in the first 96 weeks of ART in two groups of patients: prevalent TB (started ART while on TB treatment), unrecognised TB (developed TB within 6 months after start ART).


Included were 511 patients with a median baseline CD4 count of 57 cells/mm(3) (interquartile range: 22-130), of whom 368 (72%) had prevalent TB and 143 (28%) had unrecognised TB. Compared with prevalent TB, unrecognised TB was associated with lower CD4 count recovery at 96 weeks: -22.3 cells/mm(3) (95% confidence interval -43.2 to -1.5, P = 0.036). These estimates were adjusted for gender, age, baseline CD4 count and the use of zidovudine-based regimen.


Unrecognised TB at the time of ART initiation resulted in impaired CD4 recovery compared with TB treated before ART initiation. More vigilant screening with more sensitive and rapid TB diagnostics prior to ART initiation is needed to decrease the risk of ART-associated TB and sub-optimal immune reconstitution.


HIV; VIH; cadre à ressources limitées; emplazamiento con recursos limitados; immune reconstitution; infección oportunista; infection opportuniste; opportunistic infection; reconstitución inmune; reconstitution immunitaire; resource‐limited setting

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