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Adoption of evidence-informed guidelines in prescribing protease inhibitors for HIV-Tuberculosis co-infected patients on rifampicin and effects on HIV treatment outcomes in Uganda. BMC Infect Dis 2021; 21:822. [PMID: 34399706 PMCID: PMC8369708 DOI: 10.1186/s12879-021-06533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to determine how emerging evidence over the past decade informed how Ugandan HIV clinicians prescribed protease inhibitors (PIs) in HIV patients on rifampicin-based tuberculosis (TB) treatment and how this affected HIV treatment outcomes. METHODS We reviewed clinical records of HIV patients aged 13 years and above, treated with rifampicin-based TB treatment while on PIs between1st-January -2013 and 30th-September-2018 from twelve public HIV clinics in Uganda. Appropriate PI prescription during rifampicin-based TB treatment was defined as; prescribing doubled dose lopinavir/ritonavir- (LPV/r 800/200 mg twice daily) and inappropriate PI prescription as prescribing standard dose LPV/r or atazanavir/ritonavir (ATV/r). RESULTS Of the 602 patients who were on both PIs and rifampicin, 103 patients (17.1% (95% CI: 14.3-20.34)) received an appropriate PI prescription. There were no significant differences in the two-year mortality (4.8 vs. 5.7%, P = 0.318), loss to follow up (23.8 vs. 18.9%, P = 0.318) and one-year post TB treatment virologic failure rates (31.6 vs. 30.7%, P = 0.471) between patients that had an appropriate PI prescription and those that did not. However, more patients on double dose LPV/r had missed anti-retroviral therapy (ART) days (35.9 vs 21%, P = 0.001). CONCLUSION We conclude that despite availability of clinical evidence, double dosing LPV/r in patients receiving rifampicin-based TB treatment is low in Uganda's public HIV clinics but this does not seem to affect patient survival and viral suppression.
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Orazulike N, Sharma JB, Sharma S, Umeora OUJ. Tuberculosis (TB) in pregnancy - A review. Eur J Obstet Gynecol Reprod Biol 2021; 259:167-177. [PMID: 33684671 DOI: 10.1016/j.ejogrb.2021.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 11/27/2022]
Abstract
Tuberculosis (TB) is a common infectious pathology especially in low-income countries, which may complicate pregnancy. Although pulmonary TB is more common in pregnancy than extra pulmonary TB (EPTB), EPTB is becoming more common especially in those living with human deficiency virus (HIV) co infection or have other comorbidities. The diagnosis of TB may be delayed in pregnancy due to the masking of its symptoms by those of pregnancy. If diagnosed and treated on time both pulmonary TB and EPTB are associated with excellent maternal and perinatal outcome. If, however, there is delay in diagnosis and treatment then there could be adverse maternal and fetal consequences like preterm labour, fetal growth restriction and even stillbirths. Similarly severe forms of TB like disseminated disease (miliary TB) or multi drug resistant TB (MDR TB) are associated with poor outcome. Diagnosis and management is same as in non-pregnant patients. Both drug sensitive pulmonary TB and EPTB are treated with four drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) orally daily for 2 months followed by three drugs (isoniazid, rifampicin and ethambutol) orally daily for 4 months. Drug resistant TB is treated with second line drugs with caution, as some of these drugs are teratogenic. Optimum antenatal care and nutrition therapy along with anti-tuberculosis drugs provide for optimum maternal and perinatal outcome. This review discusses maternal and perinatal outcomes, diagnosis and management of pulmonary TB and extrapulmonary TB as well as perinatal tuberculosis.
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Affiliation(s)
- Ngozi Orazulike
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
| | - J B Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sangeeta Sharma
- Department of Paediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Odidika U J Umeora
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria
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Jhaj R, Sharma S, Sabir M, Kokane A. A pilot study to determine the occurrence of concomitant diseases and drug intake in patients on antituberculosis therapy. J Family Med Prim Care 2018; 7:414-419. [PMID: 30090786 PMCID: PMC6060940 DOI: 10.4103/jfmpc.jfmpc_103_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: Altered pharmacokinetics of antituberculosis (anti-TB) drugs due to interaction with non-TB medications or concomitant diseases may lead to suboptimal plasma levels of the affected drugs and hence contribute to the emergence of drug resistance in mycobacteria. Yet, few studies have investigated the prevalence of concomitant drug intake or concurrent diseases in patients on anti-TB therapy (ATT). The objective of this study is to study the prevalence of concomitant diseases and intake of non-TB drugs in patients on ATT. Methods: Adult patients who were undergoing treatment for TB at a directly observed treatment short-course (DOTS) center were interviewed to find out any concomitant drug intake and ailments they were suffering from. Data were also collected from the patients’ treatment cards. Results: A total of 105 patients were interviewed for the study over a period of 1 month. Among these, 66 (62.9%) patients reported having taken a non-ATT drug in the last 3 months, 61 (58.1%) of which were drugs that may affect the ATT. A comparable number of patients (61 [58.1%]) reported suffering from one or the other concurrent illnesses or symptoms while on DOTS, including one patient with AIDS and eight with diabetes mellitus. Fluoroquinolones had been prescribed to four patients while on DOTS. Conclusion: A large proportion of the patients with TB were found to be on non-TB concomitant medications including drugs with potential for interactions that are capable of affecting ATT outcomes. It is, therefore, important that the patients and prescribing physicians be aware of any possible drug interactions.
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Affiliation(s)
- Ratinder Jhaj
- Department of Pharmacology and Toxicology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Shweta Sharma
- Department of Pharmacology and Toxicology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Mohammed Sabir
- Department of Medical Student, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Arun Kokane
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Atilola G, Randle T, Obadara T, Komolafe IO, Odutolu G, Olomu J, Adenuga L. Epidemiology of HIV and Tuberculosis in pregnant women, South West Nigeria. J Infect Public Health 2018; 11:826-833. [PMID: 30392526 DOI: 10.1016/j.jiph.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/05/2018] [Accepted: 06/10/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pregnant women remain the most vulnerable high-risk population to the devastating impact of the on-going human immunodeficiency virus (HIV) generalized epidemic and co-infection with Tuberculosis in Nigeria. By the end of 2017, the country ranked the second highest in adult HIV-infected individuals and the highest population of orphans due to AIDS in sub-Saharan Africa. We assessed the epidemiology of HIV among pregnant women across ten facilities in south-west Nigeria. METHODS This is a cross-sectional study design in which 353 pregnant women randomly selected across ten health care facilities in two states in south west Nigeria. This study was conducted between January and May 2015. HIV testing was conducted and active tuberculosis screening was implemented using the fluorescence microscopy. In addition, a structured questionnaire was administered to elicit risk factors of HIV infection and syndromic Tuberculosis in the study population. RESULTS We found a 5.1% (18/353:95% CI:3.0%-8.0%) rate of HIV and 0% active tuberculosis in the study population. HIV positive pregnant women were 6 times more likely to have blood transfusion with greater odds of infection found in pregnant women with history of blood transfusion in the previous three months (OR:3.27, 95% CI:0.44-24.36). Pregnant women who tested HIV negative had 70% reduction in odds of infection (OR:0.21:95% CI:0.06-0.77). CONCLUSIONS This study suggests a possible strong epidemiological link between HIV infection and recent blood transfusion among pregnant women attending ante-natal clinics in south west Nigeria. We therefore recommend further study to develop a more robust estimate of blood transfusion and the risk of HIV in pregnant women in Nigeria.
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Affiliation(s)
- Glory Atilola
- Department of Biological Sciences, Redeemers University, Ede, Osun State, Nigeria; Department of Mathematics and Statistics, Northumbria University, Newcastle Upon Tyne, UK
| | - Taiwo Randle
- Department of Biological Sciences, Redeemers University, Ede, Osun State, Nigeria
| | - Tomisin Obadara
- Department of Biological Sciences, Redeemers University, Ede, Osun State, Nigeria
| | - Isaac O Komolafe
- Department of Biological Sciences, Redeemers University, Ede, Osun State, Nigeria
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Jaiswal S, Sharma A, Shukla M, Lal J. Simultaneous LC-MS-MS Determination of Lopinavir and Rifabutin in Human Plasma. J Chromatogr Sci 2018; 55:617-624. [PMID: 28334925 DOI: 10.1093/chromsci/bmx016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/21/2017] [Indexed: 11/15/2022]
Abstract
Tuberculosis (TB) with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome represents the most common infectious diseases worldwide. Anti-TB drugs are used concurrently with antiretroviral drug for treatment of TB-HIV co-morbidities. Due to lower risk of interaction with protease inhibitors, rifabutin is preferred over rifampicin in treatment of HIV and TB co-morbidity. A simple and specific liquid chromatography tandem mass spectrometry method was developed for quantification of rifabutin (RBT) and lopinavir (LPV) simultaneously in human plasma. Following extraction using 60% n-hexane in ethyl acetate, the processed samples were chromatographed on a Discovery HS C18 column (5 μm, 50 × 4.6 mm, id) using mobile phase [85% acetonitrile in ammonium acetate buffer (10 mM, pH 4.5)] at a flow rate of 0.7 mL/min. Mass spectrometric detection was performed in positive electrospray ionization mode using multiple reaction monitoring (RBT, m/z 847.7 → 815.4; LPV, m/z 629.6 → 447.4). Raloxifene and phenacetin were used as internal standards for RBT and LPV, respectively. Linearity was established in the range of 1-1,000 ng/mL and 0.5-10 µg/mL (R2 ≥ 0.99) for RBT and LPV, respectively. The recovery of LPV and RBT were always >90 and >50%, respectively. The precisions and accuracies were well within the acceptable limits of variation.
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Affiliation(s)
- Swati Jaiswal
- Pharmacokinetics & Metabolism Division, CSIR-Central Drug Research Institute, Sector 10, Jankipuram Extension, Sitapur Road, Lucknow 226031, India.,Academy of Scientific and Innovative Research, Mathura Road, New Delhi 110 025, India
| | - Abhisheak Sharma
- Pharmacokinetics & Metabolism Division, CSIR-Central Drug Research Institute, Sector 10, Jankipuram Extension, Sitapur Road, Lucknow 226031, India.,Academy of Scientific and Innovative Research, Mathura Road, New Delhi 110 025, India
| | - Mahendra Shukla
- Pharmacokinetics & Metabolism Division, CSIR-Central Drug Research Institute, Sector 10, Jankipuram Extension, Sitapur Road, Lucknow 226031, India.,Academy of Scientific and Innovative Research, Mathura Road, New Delhi 110 025, India
| | - Jawahar Lal
- Pharmacokinetics & Metabolism Division, CSIR-Central Drug Research Institute, Sector 10, Jankipuram Extension, Sitapur Road, Lucknow 226031, India.,Academy of Scientific and Innovative Research, Mathura Road, New Delhi 110 025, India
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John SF, Aniemeke E, Ha NP, Chong CR, Gu P, Zhou J, Zhang Y, Graviss EA, Liu JO, Olaleye OA. Characterization of 2-hydroxy-1-naphthaldehyde isonicotinoyl hydrazone as a novel inhibitor of methionine aminopeptidases from Mycobacterium tuberculosis. Tuberculosis (Edinb) 2016; 101S:S73-S77. [PMID: 27856197 DOI: 10.1016/j.tube.2016.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Mycobacterium tuberculosis (Mtb) and the Human Immunodeficiency Virus (HIV) pose a major public health threat. The 2015 World Health Organization (WHO) report estimates that one in three HIV deaths is due to Mtb, the causative agent of Tuberculosis (TB). The lethal synergy between these two pathogens leads to a decline in the immune function of infected individuals as well as a rise in morbidity and mortality rates. The deadly interaction between TB and HIV, along with the heightened emergence of drug resistance, drug-drug interactions, reduced drug efficacy and increased drug toxicity, has made the therapeutic management of co-infected individuals a major challenge. Hence, the development of new drug targets and/or new drug leads are imperative for the effective therapeutic management of co-infected patients. Here, we report the characterization of 2-hydroxy-1-naphthaldehyde isonicotinoyl hydrazone (311), a known inhibitor of HIV-1 replication and transcription as a new inhibitor of methionine aminopeptidases (MetAPs) from Mycobacterium tuberculosis: MtMetAP1a and MtMetAP1c. MetAP is a metalloprotease that removes the N-terminal methionine during protein synthesis. The essential role of MetAP in microbes makes it a promising chemotherapeutic target. We demonstrated that 311 is a potent and selective inhibitor of MtMetAP1a and MtMetAP1c. Furthermore, we found that 311 is active against replicating and aged non-growing Mtb at low micromolar concentrations. These results suggest that 311 is a promising lead for the development of novel class of therapeutic agents with dual inhibition of TB and HIV for the treatment of TB-HIV co-infection.
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Affiliation(s)
- Sarah F John
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX 77004, USA
| | - Emmanuel Aniemeke
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX 77004, USA
| | - Ngan P Ha
- Department of Pathology and Genomic Medicine, The Methodist Hospital Research Institute, Houston, TX 77030, USA
| | - Curtis R Chong
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Peihua Gu
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jiangbing Zhou
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Neurosurgery, Yale University, New Haven, CT 06510, USA
| | - Ying Zhang
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, The Methodist Hospital Research Institute, Houston, TX 77030, USA
| | - Jun O Liu
- Department of Pharmacology and Molecular Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
| | - Omonike A Olaleye
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX 77004, USA.
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Sara C, Elsa H, Baijayanti M, Lennartsdotter EM. Clinical Correlates and Drug Resistance in HIV-Infected and -Uninfected Pulmonary Tuberculosis Patients in South India. ACTA ACUST UNITED AC 2016; 6:87-100. [PMID: 27708985 PMCID: PMC5047007 DOI: 10.4236/wja.2016.63013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine demographics, clinical correlates, sputum AFB (acid fast bacilli) smear grading DOTS (Directly Observed Therapy Short Course) uptake, and drug resistance in a cohort of newly-diagnosed, smear positive pulmonary tuberculosis (TB) patients with respect to HIV status at baseline, and compare smear conversion rates, side effects and mortality after two months. DESIGN A prospective study among 54 HIV positive and 41 HIV negative pulmonary TB patients. Data were collected via face-to-face interviews, review of medical records, and lab tests. RESULTS HIVTB co-infected patients, though more symptomatic at baseline, showed more improvement in their symptoms compared to HIV-uninfected TB patients at follow-up. The HIV co-infected group had more prevalent perceived side effects, and sputum smear positivity was marginally higher compared to the HIV negative group at follow-up. Mortality was higher among the HIV-infected group. Both groups had high rates of resistance to first-line anti-tubercular drugs, particularly isoniazid. There was no significant difference in the drug resistance patterns between the groups. CONCLUSIONS Prompt initiation and provision of daily regimens of ATT (Anti-Tubercular treatment) along with ART (Anti-Retroviral treatment) via ART centers is urgently needed in India. As resistance to ART and/or ATT is directly linked to medication non-adherence, the use of counseling, regular reinforcement, early detection and appropriate intervention strategies to tackle this complex issue could help prevent premature mortality and development of resistance in HIV-TB co-infected patients. The high rate of isoniazid resistance might preclude its use in India as prophylaxis for latent TB in HIV infected persons as per the World Health Organization (WHO) guideline.
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Affiliation(s)
- Chandy Sara
- Department of Medicine, St John's Medical College, Bangalore, India
| | - Heylen Elsa
- Center for AIDS Prevention Studies, University of California, San Francisco, USA
| | - Mishra Baijayanti
- Department of Microbiology, St John's Medical College, Bangalore, India
| | - Ekstrand Maria Lennartsdotter
- Center for AIDS Prevention Studies, University of California, San Francisco, USA; St John's Research Institute, Bangalore, India
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Garg G, Pande M, Agrawal A, Li J, Kumar R. Investigation of 4-amino-5-alkynylpyrimidine-2(1H)-ones as anti-mycobacterial agents. Bioorg Med Chem 2016; 24:1771-7. [PMID: 26988804 DOI: 10.1016/j.bmc.2016.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/23/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Abstract
In vitro anti-mycobacterial activities of novel 4-amino-5-alkynylpyrimidine-2(1H)-ones were investigated. 4-Amino-5-heptynylpyrimidine-2(1H)-one (3) and 4-amino-5-(2-phenylethynyl)pyrimidine-2(1H)-one (7) displayed potent in vitro activity against Mycobacterium bovis and Mycobacterium tuberculosis. Compounds 3 and 7 were also assessed for their in vivo activity in BALB/c mice infected with M. tuberculosis (H37Ra). Both compounds showed promising in vivo efficacy at a dose of 25 mg/kg for 2 weeks. Importantly, compounds 3 and 7 interacted synergistically with the front-line anti-tuberculosis drug isoniazid in vitro and in vivo. These results suggest that this class of compounds has strong anti-mycobacterial potential.
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Affiliation(s)
- Gaurav Garg
- Department of Pharmacy, Mangalayatan University, Aligarh, UP, India
| | - Milind Pande
- School of Pharmacy, People's University, Bhopal, MP, India
| | - Ambika Agrawal
- 728 HMRC, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada
| | - Jie Li
- Department of Surgery, University of Alberta, Edmonton, AB T6G 2S2, Canada
| | - Rakesh Kumar
- 728 HMRC, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada.
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[GESIDA/National AIDS Plan: Consensus document on antiretroviral therapy in adults infected by the human immunodeficiency virus (Updated January 2015)]. Enferm Infecc Microbiol Clin 2015; 33:543.e1-43. [PMID: 25959461 DOI: 10.1016/j.eimc.2015.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/08/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This consensus document is an update of combined antiretroviral therapy (cART) guidelines and recommendations for HIV-1 infected adult patients. METHODS To formulate these recommendations, a panel composed of members of the AIDS Study Group and the AIDS National Plan (GeSIDA/Plan Nacional sobre el Sida) reviewed the efficacy and safety advances in clinical trials, and cohort and pharmacokinetic studies published in medical journals (PubMed and Embase) or presented in medical scientific meetings. The strength of the recommendations, and the evidence that supports them, are based on modified criteria of the Infectious Diseases Society of America. RESULTS In this update, cART is recommended for all patients infected by type 1 human immunodeficiency virus (HIV-1). The strength and level of the recommendation depends on the CD4+T-lymphocyte count, the presence of opportunistic diseases or comorbid conditions, age, and prevention of transmission of HIV. The objective of cART is to achieve an undetectable plasma viral load. Initial cART should always comprise a combination of 3 drugs, including 2 nucleoside reverse transcriptase inhibitors, and a third drug from a different family. Three out of the ten recommended regimes are regarded as preferential (all of them with an integrase inhibitor as the third drug), and the other seven (based on a non-nucleoside reverse transcriptase inhibitor, a ritonavir-boosted protease inhibitor, or an integrase inhibitor) as alternatives. This update presents the causes and criteria for switching cART in patients with undetectable plasma viral load, and in cases of virological failure where rescue cART should comprise 3 (or at least 2) drugs that are fully active against the virus. An update is also provided for the specific criteria for cART in special situations (acute infection, HIV-2 infection, and pregnancy) and with comorbid conditions (tuberculosis or other opportunistic infections, kidney disease, liver disease, and cancer). CONCLUSIONS These new guidelines update previous recommendations related to cART (when to begin and what drugs should be used), how to monitor and what to do in case of viral failure or drug adverse reactions. cART specific criteria in comorbid patients and special situations are equally updated.
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Gobis K, Foks H, Suchan K, Augustynowicz-Kopeć E, Napiórkowska A, Bojanowski K. Novel 2-(2-phenalkyl)-1H-benzo[d]imidazoles as antitubercular agents. Synthesis, biological evaluation and structure–activity relationship. Bioorg Med Chem 2015; 23:2112-20. [DOI: 10.1016/j.bmc.2015.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
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Hanrahan CF, Shah M. Economic challenges associated with tuberculosis diagnostic development. Expert Rev Pharmacoecon Outcomes Res 2014; 14:499-510. [PMID: 24766367 PMCID: PMC4605384 DOI: 10.1586/14737167.2014.914438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tuberculosis remains a global health crisis in part due to underdiagnosis. Technological innovations are needed to improve diagnostic test accuracy and reduce the reliance on expensive laboratory infrastructure. However, there are significant economic challenges impeding the development and implementation of new diagnostics. The aim of this piece is to examine the current state of TB diagnostics, outline the unmet needs for new tests, and detail the economic challenges associated with development of new tests from the perspective of developers, policy makers and implementers.
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Affiliation(s)
- Colleen F. Hanrahan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., E6039, Baltimore, MD 21205, USA
| | - Maunank Shah
- Department of Medicine, Johns Hopkins School of Medicine, 725 N. Wolfe St., Room 224, Baltimore, MD 21205, USA
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[GeSIDA/National AIDS Plan: Consensus document on antiretroviral therapy in adults infected by the human immunodeficiency virus (Updated January 2014)]. Enferm Infecc Microbiol Clin 2014; 32:446.e1-42. [PMID: 24953253 DOI: 10.1016/j.eimc.2014.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 02/18/2014] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This consensus document is an update of combined antiretroviral therapy (cART) guidelines for HIV-1 infected adult patients. METHODS To formulate these recommendations a panel composed of members of the Grupo de Estudio de Sida and the Plan Nacional sobre el Sida reviewed the efficacy and safety advances in clinical trials, cohort and pharmacokinetic studies published in medical journals (PubMed and Embase) or presented in medical scientific meetings. Recommendations strength and the evidence in which they are supported are based on modified criteria of the Infectious Diseases Society of America. RESULTS In this update, antiretroviral therapy (ART) is recommended for all patients infected by type 1 human immunodeficiency virus (HIV-1). The strength and grade of the recommendation varies with the clinical circumstances: CDC stage B or C disease (A-I), asymptomatic patients (depending on the CD4+ T-lymphocyte count: <350cells/μL, A-I; 350-500 cells/μL, A-II, and >500 cells/μL, B-III), comorbid conditions (HIV nephropathy, chronic hepatitis caused by HBV or HCV, age >55years, high cardiovascular risk, neurocognitive disorders, and cancer, A-II), and prevention of transmission of HIV (mother-to-child or heterosexual, A-I; men who have sex with men, A-III). The objective of ART is to achieve an undetectable plasma viral load. Initial ART should always comprise a combination of 3 drugs, including 2 nucleoside reverse transcriptase inhibitors and a third drug from a different family (non-nucleoside reverse transcriptase inhibitor, protease inhibitor, or integrase inhibitor). Some of the possible initial regimens have been considered alternatives. This update presents the causes and criteria for switching ART in patients with undetectable plasma viral load and in cases of virological failure where rescue ART should comprise 2 or 3 drugs that are fully active against the virus. An update is also provided for the specific criteria for ART in special situations (acute infection, HIV-2 infection, and pregnancy) and with comorbid conditions (tuberculosis or other opportunistic infections, kidney disease, liver disease, and cancer). CONCLUSIONS These new guidelines updates previous recommendations related to cART (when to begin and what drugs should be used), how to monitor and what to do in case of viral failure or drug adverse reactions. cART specific criteria in comorbid patients and special situations are equally updated.
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Souza JMO, Evangelista MDSN, Trajman A. Added value of QuantiFERON TB-gold in-tube for detecting latent tuberculosis infection among persons living with HIV/AIDS. BIOMED RESEARCH INTERNATIONAL 2014; 2014:294963. [PMID: 24991546 PMCID: PMC4058839 DOI: 10.1155/2014/294963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/13/2014] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To evaluate the added value of QuantiFERON TB-Gold in-Tube (QTF-GIT) over the tuberculin skin testing (TST) for detecting latent tuberculosis (TB) infection (LTBI) among patients with AIDS in a city with a low TB incidence rate (11.1/100,000 inhabitants) and universal BCG coverage. METHODS Three hundred consecutive patients with AIDS in eight outpatient sexually transmitted disease public clinics in Brasilia were submitted to QFT-IT and TST between May 2011 and March 2013. A positive result of either test was considered to be LTBI. RESULTS Median CD4-cell count was 477.5 cells/mm(3); 295 (98.3%) were using antiretroviral therapy. Eighteen patients (6%, 95% CI: 3.6%-9.3%) had LTBI, of whom 4 (1.3%, 95% CI: 0.04%-2.63%) had only a positive TST, 8 (2.7%, 95% CI: 0.8%-4.5%) had only a QFT-GIT positive test, and 6 (2%, 95% CI: 0.4%-3.6%) had positive results for both tests. This represents an 81.8% relative increase in LTBI detection when QFT-GIT is added to TST. The concordance between both tests was 96% (k = 0.48). CONCLUSIONS The QFT-GIT alone was more effective to detect LTBI than TST alone and had an 81% added value as an add-on sequential test in this population with mild immunosuppression. The cost-effectiveness of these strategies remains to be evaluated.
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Affiliation(s)
- Josiane Maria Oliveira Souza
- University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, DF, Brazil
- SHA, Conjunto 5 chácara 47, Quadra D, Arniqueiras, 71995-297 Taguatinga, DF, Brazil
| | - Maria do Socorro Nantua Evangelista
- University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, DF, Brazil
- Catholic University of Brasilia (UCB), Campus I, QS 07 Lote 01 EPCT, Águas Claras, 71966-700 Taguatinga, DF, Brazil
| | - Anete Trajman
- Federal University of Rio de Janeiro (UFRJ), Avenida Brigadeiro Trompowsky s/n°, Ilha do Fundão Prédio do Hospital Universitário Clementino Fraga Filho, 11° andar Bloco F, Sala 4, 21941-590 Rio de Janeiro, RJ, Brazil
- Montreal Chest Institute, McGill University, 3650 St. Urbain Street, Montreal, QC, Canada H2X 2P4
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BCG and BCG/DNAhsp65 vaccinations promote protective effects without deleterious consequences for experimental autoimmune encephalomyelitis. Clin Dev Immunol 2013; 2013:721383. [PMID: 24288555 PMCID: PMC3830802 DOI: 10.1155/2013/721383] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/16/2013] [Indexed: 12/29/2022]
Abstract
A prime-boost strategy conserving BCG is considered the most promising vaccine to control tuberculosis. A boost with a DNA vaccine containing the mycobacterial gene of a heat shock protein (pVAXhsp65) after BCG priming protected mice against experimental tuberculosis. However, anti-hsp65 immunity could worsen an autoimmune disease due to molecular mimicry. In this investigation, we evaluated the effect of a previous BCG or BCG/pVAXhsp65 immunization on experimental autoimmune encephalomyelitis (EAE) development. Female Lewis rats were immunized with BCG or BCG followed by pVAXhsp65 boosters. The animals underwent EAE induction and were daily evaluated for weight loss and clinical score. They were euthanized during recovery phase to assess immune response and inflammatory infiltration at the central nervous system. Previous immunization did not aggravate or accelerate clinical score or weight loss. In addition, this procedure clearly decreased inflammation in the brain. BCG immunization modulated the host immune response by triggering a significant reduction in IL-10 and IFN-γ levels induced by myelin basic protein. These data indicated that vaccination protocols with BCG or BCG followed by boosters with pVAXhsp65 did not trigger a deleterious effect on EAE evolution.
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