Clinical, microbiologic, and immunologic determinants of mortality in hospitalized patients with HIV-associated tuberculosis: A prospective cohort study

PLoS Medicine Jul 11, 2019

Schutz C, et al. - Researchers investigated clinical and microbiologic factors that impact mortality in hospitalized patients with HIV-associated tuberculosis in high-burden settings. In addition, they evaluated host soluble inflammatory mediators to describe the pathophysiological processes and the correlation between these mediators and death, as well as biomarkers of disseminated tuberculosis. They enrolled 576 adult patients with HIV hospitalized with a new diagnosis of HIV-associated tuberculosis in Cape Town. Conducting diagnostic tests for tuberculosis in blood and urine as a measure of tuberculosis dissemination, they described the immune response in the blood and compared these measures in patients who died vs those who survived. Death of 22% of patients was reported within 12 weeks; those with a larger number of positive measures for tuberculosis dissemination showed a higher likelihood of dying. Mortality was noted to be correlated with an immune profile with higher markers of the innate immune response and proteins that attract innate cells to tissue; this profile was also linked with more disseminated tuberculosis. These findings may assist in designing, evaluating, and monitoring new treatment strategies, including immune-based therapies.

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