Research and Reports in Tropical Medicine (Jun 2020)
Prevalence and Predictors of CD4+ T-Lymphocytopenia Among HIV-Negative Tuberculosis Patients in Uganda
Abstract
Joseph Baruch Baluku,1– 3 Joseph Musaazi,4 Rose Mulwana,1 Araali Robert Mugabo,1 Felix Bongomin,5 Winceslaus Katagira3 1Mulago National Referral Hospital, Pulmonology Division, Kampala, Uganda; 2Mildmay Uganda, Kampala, Uganda; 3Makerere University Lung Institute, Kampala, Uganda; 4Makerere University Infectious Disease Institute, Kampala, Uganda; 5Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, UgandaCorrespondence: Joseph Baruch BalukuMulago National Referral Hospital, Pulmonology Division, P.O. Box 7051, Kampala, UgandaTel +256706327972Email [email protected]: CD4+ T-lymphocytopenia is a risk for tuberculosis (TB) infection, reactivation and severe disease. We sought to determine the prevalence and predictors of CD4 T-lymphocytopenia among HIV-negative patients with bacteriologically confirmed TB in Uganda.Patients and Methods: Eligible participants were adult HIV-negative patients with bacteriologically confirmed TB at the National TB Treatment Centre in Uganda. CD4+ and CD8+ T-lymphocyte counts were determined by flow cytometry. We defined CD4+ T-lymphocytopenia as a CD4+ T-lymphocyte count of < 418 cells/mm3 as per the population estimate for Ugandans. We performed logistic regression analysis to determine predictors of CD4+ T-lymphocytopenia.Results: We enrolled 216 participants whose mean age (standard deviation (±SD)) was 32.5 (± 12.1) years, of whom 146 (67.6%) were males. The prevalence of CD4+ T-lymphocytopenia was 25% (54/216) (95% confidence interval (CI): 19.6– 31.2%). Patients with anaemia (adjusted odds ratio (aOR): 3.83, 95% CI: 1.59– 9.23, p = 0.003), weight loss (aOR: 3.61, 95% CI: 1.07– 12.23, p = 0.039) and a low CD8+ T-cell count (aOR: 6.10, 95% CI: 2.68– 13.89, p < 0.001) were more likely to have CD4+ T-lymphocytopenia while those with monocytosis (aOR: 0.35, 95% CI: 0.14– 0.89, p = 0.028) were less likely to have CD4+ T-lymphocytopenia.Conclusion: There was a high prevalence of CD4+ T-lymphocytopenia among HIV-negative TB patients. Patients with weight loss, anaemia and a low CD8+ count were more likely to have CD4+ T-lymphocytopenia while those with monocytosis were less likely to have CD4+ lymphocytopenia. The findings suggest that CD4+ lymphocytopenia is indicative of severe disease and globally impaired cell-mediated immune responses against TB.Keywords: HIV negative, tuberculosis, CD4+, CD8+, lymphoctyopenia, monocytosis, weight loss, anaemia
