Evaluation of Serum C-Reactive Protein Level, Erythrocyte Sedimentation Rate and CD4+ Cell Count in Predicting Tuberculosis Disease Progression in Patients with HIV Co-Infection

Abstract

Background: The challenges of managing tuberculosis in resource poor countries, especially when there is co-infection with Human Immunodeficiency virus (TB/HIV), are enormous. Serum C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR) and CD4⁺ T-cell counts were determined in this study as predictive biomarkers of severe TB infection with and without HIV infection in Uyo, Nigeria.

Materials and Methods: One hundred and seventy sputum-producing patients aged 15 to 60 years, suspected of active tuberculosis were tested for TB and HIV using standard methods. Apparently healthy blood donors were recruited as control. Serum CRP levels and CD4⁺ T cell counts were estimated using sandwich-enzyme linked immunosorbent assay and flow cytometry, respectively. ESR was estimated using the conventional Westergreen method.

Results: The mean CRP levels and ESR were significantly higher in patients with TB/HIV co-infection compared with patients with TB infection only and controls. In contrast, the mean CD4⁺ cell count was significantly lower in patients with TB/HIV co-infection compared with patients with TB infection only. The CD4⁺ cell count had significant inverse correlation with CRP and ESR. The sensitivity and positive predictive values of CRP and CD4⁺ cell count in predicting disease progression were higher in patients with TB/HIV co-infection compared with patients with TB infection only.

Conclusion: Serum CRP levels alone or its combination with ESR and/or CD4⁺ T cell count could be promising predictors of TB disease progression especially, in patients with TB/HIV co-infection.