Human Immunodeficiency Virus Type 1 and Tuberculosis Coinfection in Multinational, Resource-limited Settings: Increased Neurological Dysfunction

Clin Infect Dis. 2019 May 2;68(10):1739-1746. doi: 10.1093/cid/ciy718.


Background: AIDS Clinical Trial Group 5199 compared neurological and neuropsychological test performance of human immunodeficiency virus type 1 (HIV-1)-infected participants in resource-limited settings treated with 3 World Health Organization-recommended antiretroviral (ART) regimens. We investigated the impact of tuberculosis (TB) on neurological and neuropsychological outcomes.

Methods: Standardized neurological and neuropsychological examinations were administered every 24 weeks. Generalized estimating equation models assessed the association between TB and neurological/neuropsychological performance.

Results: Characteristics of the 860 participants at baseline were as follows: 53% female, 49% African; median age, 34 years; CD4 count, 173 cells/μL; and plasma HIV-1 RNA, 5.0 log copies/mL. At baseline, there were 36 cases of pulmonary, 9 cases of extrapulmonary, and 1 case of central nervous system (CNS) TB. Over the 192 weeks of follow-up, there were 55 observations of pulmonary TB in 52 persons, 26 observations of extrapulmonary TB in 25 persons, and 3 observations of CNS TB in 2 persons. Prevalence of TB decreased with ART initiation and follow-up. Those with TB coinfection had significantly poorer performance on grooved pegboard (P < .001) and fingertapping nondominant hand (P < .01). TB was associated with diffuse CNS disease (P < .05). Furthermore, those with TB had 9.27 times (P < .001) higher odds of reporting decreased quality of life, and had 8.02 times (P = .0005) higher odds of loss of productivity.

Conclusions: TB coinfection was associated with poorer neuropsychological functioning, particularly the fine motor skills, and had a substantial impact on functional ability and quality of life.

Clinical trials registration: NCT00096824.

Keywords: HIV; cognitive impairment; neuropsychological functioning; resource-limited; tuberculosis.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cognitive Dysfunction / diagnosis*
  • Cognitive Dysfunction / microbiology
  • Cognitive Dysfunction / virology
  • Coinfection / complications*
  • Coinfection / microbiology
  • Coinfection / virology
  • Female
  • HIV Infections / complications*
  • HIV-1
  • Health Resources / supply & distribution*
  • Humans
  • Internationality
  • Longitudinal Studies
  • Male
  • Motor Skills
  • Nervous System Diseases / diagnosis*
  • Nervous System Diseases / microbiology
  • Nervous System Diseases / virology
  • Neuropsychological Tests
  • Prospective Studies
  • Quality of Life
  • Tuberculosis / complications*
  • Tuberculosis / virology

Associated data