High Sensitivity C-Reaction Protein in HIV care: tuberculosis diagnosis and short-term mortality in a cohort of Kenyan HIV patients in the DREAM program.

Abstract Objective TB represents the leading cause of death in HIV + people. In Kenya, 140,000 new TB cases occurred in 2019 and 13,000 HIV + patients died due to TB. Our objective is to investigate the role of HS-CRP in TB diagnosis and mortality predictivity in HIV + patients. Methods In the IDEA-TB study we enrolled HIV + adult patients attending 3 DREAM Centers in Kenya who were suspected of having TB. Urinary LF-LAM-test, serum HS-CRP and Gene Xpert were performed. 6-month survival was evaluated. Results 574 patients were enrolled. Median age, BMI and CD4 count were: 45years(37-54), 20.5 kg/m2(18.5–23.69), 477cells/ml(290-700). TB was confirmed in 87(15.2%) patients. Concordance between Xpert and LAM test was 87.1%. HS-CRP was higher in TB patients (35.39 mg/L vs 9.21 mg/L). Malnutrition and elevated HS-CRP were associated with TB (AOR 2.2[1.23-3.90] and 6.8[3.75-12.60]). 9(1.6%) patients died during follow up. No single factor was associated with mortality, only the combination of malnutrition and elevated HS-CRP was highly predictive of death (OR 9.8[1.88-50.95]); the association was stronger in TB- patients (33.3% vs 1.0%, OR 47.6 [7.03-322.23]). Conclusion TB diagnosis in HIV + patient remains challenging. HS-CRP could play a role in predicting early mortality in symptomatic patients.