A HOSPITAL BASED OBSERVATIONAL STUDY ON HIV-TB COINFECTION
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ABSTRACT BACKGROUND: HIV is the leading cause of failure to reach TB control targets in high-HIV settings. TB on the other hand enhances progression of HIV infection to AIDS. MATERIAL AND METHODS : An observational study was conducted in which a total of 573 newly diagnosed HIV-positive patients enrolled at ART center, KGMU, Lucknow between May 2021 to June 2022 were taken of which 80 patients had newly diagnosed TB. These HIV-TB co-infected patients were analyzed for demographic factors. Also, CD4 counts were done at the time of enrolment on ART and then about six to eight months later. For comparision, of the 493 HIV only patients, 50 age and sex matched consecutive patients for whom baseline and follow up CD4 counts were available were enrolled as controls. The change from baseline CD4 count was calculated using paired t-test and Wilcoxon signed rank test. RESULTS : In present study,among HIV-TB coinfected patients, baseline CD4 levels were 194.52±162.27, and follow up CD4 levels were 285.09±170.33. An increment of 90.57±165.60 in mean CD4 levels was observed which was statistically significant(t=4.019; p<0.001 ). CONCLUSION : Significant rise in CD4 counts was observed in HIV-TB coinfected patients started on ART and ATT.
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Many thanks to authors for their submission, where they aim to examine the epidemiological and clinical profile of TB-HIV co-infected patients in Northern India; and to assess the impact of TB on recovery of CD4+ T cells. Overall, while the manuscript addresses interesting and informative points, it is poorly written. It needs to be re-written with a particular focus and grammar, namely sentence structure, and spelling. Abbreviations are also used throughout the manuscript, these should be stated explicitly what they stand for when first used, not randomly within the body of the manuscript. I also have major reservations on the results and participant selection. 80 patients were co-infected with HIV/TB, but data was only available for 54 patients – 7 transfers, 4 lost to follow-up and 14 died. That leaves 1 patient unaccounted for.
Many thanks to authors for their submission, where they aim to examine the epidemiological and clinical profile of TB-HIV co-infected patients in Northern India; and to assess the impact of TB on recovery of CD4+ T cells. Overall, while the manuscript addresses interesting and informative points, it is poorly written. It needs to be re-written with a particular focus and grammar, namely sentence structure, and spelling. Abbreviations are also used throughout the manuscript, these should be stated explicitly what they stand for when first used, not randomly within the body of the manuscript. I also have major reservations on the results and participant selection. 80 patients were co-infected with HIV/TB, but data was only available for 54 patients – 7 transfers, 4 lost to follow-up and 14 died. That leaves 1 patient unaccounted for. There were 493 HIV-only patients. Yet, only 50 matched age and sex controls. This seems highly implausible. A full detailed description is warranted to validate this claim. Additionally, a waiver of consent was taken for these controls, yet their data is collected and compared. Informed consent should have been taken for this cohort as well, unless directed by the Ethics Committee – which should be stated. I also have significant reservations on the diagnosis of TB. Majority (80%) of cases of TB were diagnosed clinically. Why? I understand that resources are limited but only a very limited proportion of the participants had any pathological investigations. What were the clinical parameters that physicians used to label a patient as having someone with TB. I understand that the prevalence among this cohort is high, so likely possibility; but were other opportunistic respiratory diseases out-ruled? Like MAC, CMV, PJP etc? MTB GeneXpert was done for only 20% of people; furthermore, was this on sputum samples or deeper respiratory samples like a bronchoalveolar lavage? Are Mantoux or Quantiferon not available? Additionally, if TB was not diagnosed on the GeneXpert to detect rifampicin-resistance, and culture was not positive in any cases, how was a decision made on which anti-tubercular medications to administer? I also agree with the Reviewer in that it is difficult to draw meaningful conclusion on the effect of ART on CD4+ T cell count as the baseline CD4+ T cell count was not the same between compared groups. I appreciate that this was attempted to be addressed by measuring the proportional increase, but even that is affected by many confounding factors. Was compliance assessed? Was ART therapy the same across all patients? Were HIV Viral loads collected and examined?
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Comments to Author
For the first page, I prefer the conclusion in page 13 to be written in the abstract. Table 3 need to be reviewed - South Sudan and Tamil Nadu is not included in the table.
Please rate the manuscript for methodological rigour
Satisfactory
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical …
Comments to Author
For the first page, I prefer the conclusion in page 13 to be written in the abstract. Table 3 need to be reviewed - South Sudan and Tamil Nadu is not included in the table.
Please rate the manuscript for methodological rigour
Satisfactory
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
In this study, the authors examined 573 HIV patients and followed them up for 6-8 weeks, comparing the clinical characteristics of HIV-TB coinfected patients (n=54) and those with HIV only (n=50), particularly focusing on the differences in baseline CD4+ T cell counts between the two groups and their response to antiretroviral therapy. This is an interesting study. However, I have some questions regarding the study's results that the authors need to address in order: 1. There were a total of 493 HIV only patients, but only 50 were ultimately matched for age and gender, which is quite implausible. The authors need to provide detailed explanations on how the samples were excluded and list the gender and age of the other patients. 2. The authors compared the recovery of CD4+ T cells in both patient …
Comments to Author
In this study, the authors examined 573 HIV patients and followed them up for 6-8 weeks, comparing the clinical characteristics of HIV-TB coinfected patients (n=54) and those with HIV only (n=50), particularly focusing on the differences in baseline CD4+ T cell counts between the two groups and their response to antiretroviral therapy. This is an interesting study. However, I have some questions regarding the study's results that the authors need to address in order: 1. There were a total of 493 HIV only patients, but only 50 were ultimately matched for age and gender, which is quite implausible. The authors need to provide detailed explanations on how the samples were excluded and list the gender and age of the other patients. 2. The authors compared the recovery of CD4+ T cells in both patient groups after treatment and concluded that the effect of treatment on increasing CD4+ T cells was more pronounced in HIV only patients. However, since the baseline CD4+ T cell counts of HIV-TB co-infected patients and HIV only patients were not consistent, the recovery of CD4+ T cells through antiretroviral therapy may be influenced by the baseline CD4+ T cell counts. Additionally, despite the greater increase in CD4+ T cell counts in the HIV only group through antiretroviral therapy, the proportion of baseline increase was lower compared to HIV-TB co-infected patients. The authors need to provide a detailed explanation of this result in the discussion section. 3. One of the main objectives of the authors was to study the impact of TB on the recovery of CD4 counts. Similarly, since the baseline CD4+ T cell counts of the two groups are not consistent, the effect of antiretroviral therapy on increasing CD4+ T cells may not only be influenced by TB infection but also by baseline CD4+ T cell counts. The authors need to address this in the discussion. 4. Abbreviations should be avoided in the abstract as much as possible. If necessary, provide the full term, such as ART. 5. The results section of the abstract is incomplete, and it should also describe the CD4+ T cell status of HIV only patients. The conclusion section should also reflect the differences between HIV-TB co-infected and HIV only patients. 6. There are some spelling errors, such as "Table 3 clinico," which should be corrected to "Table 3 clinical."
Please rate the manuscript for methodological rigour
Satisfactory
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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