Age, sex, and nutritional status modify the CD4+ T-cell recovery rate in HIV–tuberculosis co-infected patients on combination antiretroviral therapy

• Age was examined in relation to CD4+ T-cell rise in HIV–tuberculosis (TB)-co-infected adults during combined antiretroviral therapy (cART).
• Given cART, the age-related CD4+ T-cell recovery rate depended on sex and nutritional status.
• Young age predicted CD4+ T-cell rise among women and normally nourished patients.
• Optimal nutrition in TB–HIV-co-infected patients may enhance CD4+ T-cell recovery given cART.

SummaryBackgroundBaseline age and combination antiretroviral therapy (cART) were examined as determinants of CD4+ T-cell recovery during 6 months of tuberculosis (TB) therapy with/without cART. It was determined whether this association was modified by patient sex and nutritional status.MethodsThis longitudinal analysis included 208 immune-competent, non-pregnant, ART-naive HIV-positive patients from Uganda with a first episode of pulmonary TB. CD4+ T-cell counts were measured using flow cytometry. Age was defined as ≤24, 25–29, 30–34, and 35–39 vs. ≥40 years. Nutritional status was defined as normal (>18.5 kg/m2) vs. underweight (≤18.5 kg/m2) using the body mass index (BMI). Multivariate random effects linear mixed models were fitted to estimate differences in CD4+ T-cell recovery in relation to specified determinants.ResultscART was associated with a monthly rise of 15.7 cells/μl (p < 0.001). Overall, age was not associated with CD4+ T-cell recovery during TB therapy (p = 0.655). However, among patients on cART, the age-associated CD4+ T-cell recovery rate varied by sex and nutritional status, such that age <40 vs. ≥40 years predicted superior absolute CD4+ T-cell recovery among females (p = 0.006) and among patients with a BMI ≥18.5 kg/m2 (p < 0.001).ConclusionsTB-infected HIV-positive patients aged ≥40 years have a slower rate of immune restoration given cART, particularly if BMI is >18.5 kg/m2 or they are female. These patients may benefit from increased monitoring and nutritional support during cART.