Biochemical Value Dynamics in Patients with Multidrug‑Resistant Tuberculosis/HIV with CD4+ Lymphocyte Cells below 50 Cells/μCL and its Variability in the Application of Adjuvant Immunoglobulin Therapy

Abstract

Treatment of the patients with multidrug‑resistant tuberculosis (MDR‑TB)/HIV coinfection in a state of severely suppressed immune system remains under effcient. Aims: The aim of this study was to assess the effectiveness of adjuvant immunoglobulin therapy in TB/HIV patients. Settings and Design: The relationship between biochemical indexes in the patients with MDR‑TB/HIV co‑infection and adjuvant immunoglobulin therapy. Materials and Methods: The study involved 52 HIV‑positive patients with MDR‑TB and CD4+ lymphocyte cells below 50 cells/μCL. Patients in control group (Group 1) and in basic group (Group 2) received standard treatment with second‑line antituberculosis agents and antiretroviral agents. In addition patients in basic group were treated by immunoglobulin G intravenously. The evaluation of biochemical parameters such as bilirubin level, thymol test, the activity of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma‑glutamyltransferase (GGT) was carried out on automatic analyzer HumaStar 300 at the beginning and after 0.5–8 months of treatment. Statistical analysis was performed using the Statistica 10.0 software (Stat. Soft Inc., USA). Kruskal–Wallis, ANOVA, and Chi‑square tests were used in this study. Results: After 8 months of treatment, studied biochemical indexes were lower in Group 2 than in patients from Group 1. For example, the number of patients in Group 2 with increased bilirubin level was 1.7 times more than in Group 1 (Р < 0.05), with increased ALT, AST, or GGT activity in 2.5 times (Р < 0.01), 2.7 times (Р < 0.01), or 2.4 times (Р < 0.05) correspondently, comparatively with Group 1. Conclusion: The usage of immunoglobulins intravenously in the group of patients with MDR‑TB associated with HIV infection, with CD4+ level <50 cells/µCL, is appropriate and essential because it improves treatment outcome.