Cytokine responses and progression to active tuberculosis in HIV-1-infected Ugandans: a prospective study

Trans R Soc Trop Med Hyg. 2004 Nov;98(11):660-70. doi: 10.1016/j.trstmh.2004.01.007.

Abstract

Identifying correlates of immunity or susceptibility to disease promotes understanding of pathogenesis and development of diagnostic tools, treatments, and vaccines. There is evidence that type 1 cytokine responses are associated with protection against tuberculosis, and suppression of type 1, or switching to type 2 responses, with susceptibility, but this has not been studied prospectively. We studied a cohort of 631 HIV-1-infected Ugandan adults. At enrollment we performed whole blood cultures for type 1 (interferon [IFN]-gamma, interleukin [IL]-2) and type 2/immunosuppressive (IL-5, IL-10) responses to mycobacterial antigens (purified protein derivative [PPD] and culture filtrate proteins [CFP]). The incidence of tuberculosis was not associated with IFN-gamma responses, but was higher among participants with IL-2 responses (adjusted rate ratios [RR]: PPD 3.48; CFP 3.99; P < 0.001). For tuberculin skin test-positive participants, high incidence was also associated with an IL-10 response to PPD (adjusted RR 6.24, P = 0.03); for those with a BCG scar, high incidence was associated with positive IL-5 responses (adjusted RRs: PPD 3.64, P = 0.006; CFP 3.44, P = 0.04). The association with IL-2 production may reflect a response to tuberculous infection or to activating disease; the associations with IL-10 and IL-5 are in keeping with the expected role of immunosuppressive or type 2 cytokines.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antigens, Bacterial / immunology
  • BCG Vaccine / therapeutic use
  • CD4 Lymphocyte Count
  • Cytokines / blood
  • Cytokines / immunology*
  • Disease Progression
  • Female
  • HIV Infections / blood
  • HIV Infections / epidemiology
  • HIV Infections / immunology*
  • HIV-1*
  • Humans
  • Incidence
  • Interferon-gamma / blood
  • Interferon-gamma / immunology
  • Interleukin-10 / blood
  • Interleukin-10 / immunology
  • Interleukin-2 / blood
  • Interleukin-2 / immunology
  • Interleukin-5 / blood
  • Interleukin-5 / immunology
  • Male
  • Prospective Studies
  • Tuberculosis / blood
  • Tuberculosis / epidemiology
  • Tuberculosis / immunology*
  • Tuberculosis, Pulmonary / blood
  • Tuberculosis, Pulmonary / epidemiology
  • Tuberculosis, Pulmonary / immunology
  • Uganda / epidemiology

Substances

  • Antigens, Bacterial
  • BCG Vaccine
  • Cytokines
  • Interleukin-2
  • Interleukin-5
  • Interleukin-10
  • Interferon-gamma