High-sensitivity C-reactive protein in HIV care: Tuberculosis diagnosis and short-term mortality in a cohort of Kenyan HIV patients in the DREAM programme. (March 2021)

• Record Type: Journal Article
• Authors: Ciccacci, Fausto; Welu, Benjamin; Ndoi, Harrison; Karea, Irene; Orlando, Stefano; Brambilla, Davide; Munene, Kenneth; Giglio, Piero; Opanga, Brenda; Ronoh, Aiban; Mukwanjagi, Scolastica; Mwiraria, Raymond; Guidotti, Giovanni; Marazzi, Maria Cristina
• Is Part Of: International journal of infectious diseases. Volume 104(2021)
• Page Start: 329
• Page End: 334
• Publication Date: 2021-03
• Subjects: HIV care -- Laboratory monitoring -- Tuberculosis diagnosis -- Mortality -- Kenya; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2021.01.008
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Elevated high-sensitivity C-reactive protein levels were associated with TB test results in HIV-positive Kenyan patients. Malnutrition and elevated HS-CRP were found to be associated with TB in HIV-positive patients. Combined malnutrition and elevated HS-CRP waere correlated with short-term mortality, especially in TB-negative patients. HS-CRP could play a role in HIV care services as a predictor of TB infection and short-term mortality. Abstract: Objective: Tuberculosis (TB) is the leading cause of death in HIV-positive people. In Kenya, 140 000 new TB cases occurred in 2019, and 13 000 HIV-positive patients died due to TB. The objective of this study was to investigate the role of high-sensitivity C-reactive protein (HS-CRP) in TB diagnosis and the prediction of mortality in HIV-positive patients. Methods: The IDEA-TB Study enrolled HIV-positive adult patients attending three DREAM centres in Kenya who were suspected of having TB. A lateral flow urine lipoarabinomannan assay (LF-LAM), serum HS-CRP, and GeneXpert MTB/RIF assay (Xpert MTB/RIF) were performed. Six-month survival was evaluated. Results: A total of 574 patients were enrolled. The median (interquartile range) age, body mass index, and CD4 count were 45 years (37–54 years), 20.5 kg/m 2 (18.5–23.69 kg/m 2 ), and 477 cells/mL (290–700 cells/mL), respectively. TB was confirmed in 87 (15.2%) patients. Concordance between the Xpert MTB/RIF and LF-LAM tests was 87.1%. HS-CRP was higher in TB patients (35.39 mg/l vs 9.21 mg/l). Malnutrition and elevated HS-CRP were associated with TB: odds ratio (OR) 2.5 (95% confidence interval (CI) 1.14–5.72) and OR 6.6 (95% CI 3.87–11.52), respectively. Nine (1.6%) patients died during follow-up. No single factor was associated with mortality. Only the combination of malnutrition and elevated HS-CRP was highly predictive of death (odds ratio (OR) 9.8, 95% CI 1.88–50.95); the association was stronger in TB patients (33.3% vs 1.0%; OR 47.6, 95% CI 7.03–322.23). Conclusion: TB diagnosis in HIV-positive patients remains challenging. HS-CRP could play a role in predicting early mortality in symptomatic patients.