1
|
Suárez I, Rauschning D, Schüller C, Hagemeier A, Stecher M, Lehmann C, Schommers P, Schlabe S, Vehreschild JJ, Koll C, Schwarze-Zander C, Wasmuth JC, Klingmüller A, Rockstroh JK, Fätkenheuer G, Boesecke C, Rybniker J. Incidence and risk factors for HIV-tuberculosis coinfection in the Cologne-Bonn region: a retrospective cohort study. Infection 2024; 52:1439-1448. [PMID: 38492196 PMCID: PMC11289312 DOI: 10.1007/s15010-024-02215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/13/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE The risk of developing active tuberculosis (TB) is considerably increased in people living with HIV/AIDS (PLWH). However, incidence of HIV/TB coinfection is difficult to assess as surveillance data are lacking in many countries. Here, we aimed to perform a quantitative analysis of HIV/TB coinfections within the Cologne/Bonn HIV cohort and to determine risk factors for active TB. METHODS We systematically evaluated data of patients with HIV/TB coinfection between 2006 and 2017. In this retrospective analysis, we compared HIV/TB-coinfected patients with a cohort of HIV-positive patients. The incidence density rate (IDR) was calculated for active TB cases at different time points. RESULTS During 2006-2017, 60 out of 4673 PLWH were diagnosed with active TB. Overall IDR was 0.181 cases/100 patient-years and ranged from 0.266 in 2006-2009 to 0.133 in 2014-2017. Patients originating from Sub-Saharan Africa had a significantly (p < 0.001) higher IDR (0.694/100 patient-years of observation, 95% CI [0.435-1.050]) in comparison to patients of German origin (0.053/100 patient-years of observation, 95% CI [0.028-0.091]). In terms of TB-free survival, individuals originating from countries with a TB incidence higher than 10/100,000 exhibited a markedly reduced TB-free survival compared to those originating from regions with lower incidence (p < 0.001). In 22 patients, TB and HIV infection were diagnosed simultaneously. CONCLUSION Overall, we observed a decline in the incidence density rate (IDR) of HIV/TB coinfections between 2006 and 2017. Patients originating from regions with high incidence bear a higher risk of falling ill with active TB. For PLWH born in Germany, the observed risk of active TB appears to be lower compared to other groups within the cohort. These findings should be considered when developing TB containment and screening strategies for PLWH in low-incidence countries.
Collapse
Affiliation(s)
- Isabelle Suárez
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
| | - Dominic Rauschning
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Department IB of Internal Medicine, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | - Cora Schüller
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Anna Hagemeier
- Medical Faculty and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
| | - Clara Lehmann
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Philipp Schommers
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Stefan Schlabe
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
| | - Jörg-Janne Vehreschild
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
- Medical Department 2 (Hematology/Oncology and Infectious Diseases), Center for Internal Medicine, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Carolin Koll
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Carolynne Schwarze-Zander
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
- Gemeinschaftspraxis am Kaiserplatz, Bonn, Germany
| | - Jan-Christian Wasmuth
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
| | - Angela Klingmüller
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jürgen Kurt Rockstroh
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
| | - Christoph Boesecke
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
| | - Jan Rybniker
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany.
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany.
| |
Collapse
|
2
|
Lew YL, Tan AF, Yerkovich ST, Yeo TW, Chang AB, Lowbridge CP. Pulmonary function outcomes after tuberculosis treatment in children: a systematic review and meta-analysis. Arch Dis Child 2024; 109:188-194. [PMID: 37979964 DOI: 10.1136/archdischild-2023-326151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/03/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Despite tuberculosis (TB) being a curable disease, current guidelines fail to account for the long-term outcomes of post-tuberculosis lung disease-a cause of global morbidity despite successful completion of effective treatment. Our systematic review aimed to synthesise the available evidence on the lung function outcomes of childhood pulmonary tuberculosis (PTB). METHODS PubMed, ISI Web of Science, Cochrane Library and ProQuest databases were searched for English-only studies without time restriction (latest search date 22 March 2023). Inclusion criteria were (1) patients who had TB with pulmonary involvement at age ≤18 years; (2) pulmonary function tests (PFTs) performed on patients after treatment completion; and (3) observational studies, including cohort and cross-sectional studies. We adhered to the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS From 8040 records, 5 studies were included (involving n=567 children), with spirometry measures from 4 studies included in the meta-analyses. The effect sizes of childhood TB on forced expiratory volume in the first second and forced vital capacity z-scores were estimated to be -1.53 (95% CI -2.65, -0.41; p=0.007) and -1.93 (95% CI -3.35, -0.50; p=0.008), respectively. DISCUSSION The small number of included studies reflects this under-researched area, relative to the global burden of TB. Nevertheless, as childhood PTB impacts future lung function, PFTs (such as spirometry) should be considered a routine test when evaluating the long-term lung health of children beyond their completion of TB treatment. PROSPERO registration number CRD42021250172.
Collapse
Affiliation(s)
- Yao Long Lew
- Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Angelica Fiona Tan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Stephanie T Yerkovich
- Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tsin Wen Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Anne B Chang
- Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christopher P Lowbridge
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| |
Collapse
|
3
|
Shaw B, von Bredow B, Tsan A, Garner O, Yang S. Clinical Whole-Genome Sequencing Assay for Rapid Mycobacterium tuberculosis Complex First-Line Drug Susceptibility Testing and Phylogenetic Relatedness Analysis. Microorganisms 2023; 11:2538. [PMID: 37894195 PMCID: PMC10609454 DOI: 10.3390/microorganisms11102538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
The global rise of drug resistant tuberculosis has highlighted the need for improved diagnostic technologies that provide rapid and reliable drug resistance results. Here, we develop and validate a whole genome sequencing (WGS)-based test for identification of mycobacterium tuberculosis complex (MTB) drug resistance to rifampin, isoniazid, pyrazinamide, ethambutol, and streptomycin. Through comparative analysis of drug resistance results from WGS-based testing and phenotypic drug susceptibility testing (DST) of 38 clinical MTB isolates from patients receiving care in Los Angeles, CA, we found an overall concordance between methods of 97.4% with equivalent performance across culture media. Critically, prospective analysis of 11 isolates showed that WGS-based testing provides results an average of 36 days faster than phenotypic culture-based methods. We showcase the additional benefits of WGS data by investigating a suspected laboratory contamination event and using phylogenetic analysis to search for cryptic local transmission, finding no evidence of community spread amongst our patient population in the past six years. WGS-based testing for MTB drug resistance has the potential to greatly improve diagnosis of drug resistant MTB by accelerating turnaround time while maintaining accuracy and providing additional benefits for infection control, lab safety, and public health applications.
Collapse
Affiliation(s)
- Bennett Shaw
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA; (B.S.); (B.v.B.); (A.T.); (O.G.)
| | - Benjamin von Bredow
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA; (B.S.); (B.v.B.); (A.T.); (O.G.)
- Department of Pathology, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA
| | - Allison Tsan
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA; (B.S.); (B.v.B.); (A.T.); (O.G.)
| | - Omai Garner
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA; (B.S.); (B.v.B.); (A.T.); (O.G.)
| | - Shangxin Yang
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA; (B.S.); (B.v.B.); (A.T.); (O.G.)
| |
Collapse
|
4
|
Bhatt A, Quazi Syed Z, Singh H. Converging Epidemics: A Narrative Review of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) Coinfection. Cureus 2023; 15:e47624. [PMID: 38021882 PMCID: PMC10667792 DOI: 10.7759/cureus.47624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Tuberculosis (TB), primarily caused by Mycobacterium tuberculosis (MTB), remains a leading cause of mortality in individuals living with human immunodeficiency virus (HIV) infection, posing a significant strain on healthcare systems. Coinfection of HIV and TB results in a mutually advantageous relationship that accelerates the progression of both diseases. TB is a major contributor to mortality in individuals with HIV. However, diagnosing coinfected individuals is challenging due to the prevalence of extrapulmonary TB and smear-negative disease. Over the past decade, significant progress has been made in the fight against TB, thanks to advances in molecular techniques. Yet, these molecular diagnostic assays remain inaccessible to many individuals coinfected with HIV and TB due to their high cost. To expedite treatment and reduce transmission, it is crucial to integrate HIV and TB control programs more closely, thereby minimizing diagnostic delays and enhancing early case detection. This review aims to provide a comprehensive overview of the current state of knowledge regarding the interplay between HIV and TB. It highlights recent developments in sensitive and rapid TB diagnostic tests, cutting-edge preventive strategies, and the screening of individuals coinfected with both HIV and TB. The objectives of this review are to shed light on the complex relationship between these two diseases and to emphasize the importance of integrated efforts in combating their impact on public health.
Collapse
Affiliation(s)
- Asmi Bhatt
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Zahiruddin Quazi Syed
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshit Singh
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
5
|
Mpagama SG, Byashalira KC, Chamba NG, Heysell SK, Alimohamed MZ, Shayo PJ, Kalolo A, Chongolo AM, Gitige CG, Mmbaga BT, Ntinginya NE, Alffenaar JWC, Bygbjerg IC, Lillebaek T, Christensen DL, Ramaiya KL. Implementing Innovative Approaches to Improve Health Care Delivery Systems for Integrating Communicable and Non-Communicable Diseases Using Tuberculosis and Diabetes as a Model in Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6670. [PMID: 37681810 PMCID: PMC10487244 DOI: 10.3390/ijerph20176670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 09/09/2023]
Abstract
Background: Many evidence-based health interventions, particularly in low-income settings, have failed to deliver the expected impact. We designed an Adaptive Diseases Control Expert Programme in Tanzania (ADEPT) to address systemic challenges in health care delivery and examined the feasibility, acceptability and effectiveness of the model using tuberculosis (TB) and diabetes mellitus (DM) as a prototype. Methods: This was an effectiveness-implementation hybrid type-3 design that was implemented in Dar es Salaam, Iringa and Kilimanjaro regions. The strategy included a stepwise training approach with web-based platforms adapting the Gibbs' reflective cycle. Health facilities with TB services were supplemented with DM diagnostics, including glycated haemoglobin A1c (HbA1c). The clinical audit was deployed as a measure of fidelity. Retrospective and cross-sectional designs were used to assess the fidelity, acceptability and feasibility of the model. Results: From 2019-2021, the clinical audit showed that ADEPT intervention health facilities more often identified median 8 (IQR 6-19) individuals with dual TB and DM, compared with control health facilities, median of 1 (IQR 0-3) (p = 0.02). Likewise, the clinical utility of HbA1c on intervention sites was 63% (IQR:35-75%) in TB/DM individuals compared to none in the control sites at all levels, whereas other components of the standard of clinical management of patients with dual TB and DM did not significantly differ. The health facilities showed no difference in screening for additional comorbidities such as hypertension and malnutrition. The stepwise training enrolled a total of 46 nurse officers and medical doctors/specialists for web-based training and 40 (87%) attended the workshop. Thirty-one (67%), 18 nurse officers and 13 medical doctors/specialists, implemented the second step of training others and yielded a total of 519 additional front-line health care workers trained: 371 nurses and 148 clinicians. Overall, the ADEPT model was scored as feasible by metrics applied to both front-line health care providers and health facilities. Conclusions: It was feasible to use a stepwise training and clinical audit to support the integration of TB and DM management and it was largely acceptable and effective in differing regions within Tanzania. When adapted in the Tanzania health system context, the model will likely improve quality of services.
Collapse
Affiliation(s)
- Stellah G. Mpagama
- Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania; (K.C.B.); (P.J.S.); (A.M.C.); (C.G.G.)
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro 25116, Tanzania; (N.G.C.); (B.T.M.)
| | - Kenneth C. Byashalira
- Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania; (K.C.B.); (P.J.S.); (A.M.C.); (C.G.G.)
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro 25116, Tanzania; (N.G.C.); (B.T.M.)
| | - Nyasatu G. Chamba
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro 25116, Tanzania; (N.G.C.); (B.T.M.)
- Kilimanjaro Clinical Research Institute, Moshi Kilimanjaro 25116, Tanzania
| | - Scott K. Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22908-1340, USA;
| | - Mohamed Z. Alimohamed
- Department of Internal Medicine, Hindu Manda Hospital, Ilala, Dar es Salaam 11104, Tanzania; (M.Z.A.); (K.L.R.)
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania
| | - Pendomartha J. Shayo
- Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania; (K.C.B.); (P.J.S.); (A.M.C.); (C.G.G.)
| | - Albino Kalolo
- Department of Public Health, Faculty of Medicine, St. Francis University College of Health and Allied Sciences, Ifakara 67501, Tanzania;
| | - Anna M. Chongolo
- Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania; (K.C.B.); (P.J.S.); (A.M.C.); (C.G.G.)
| | - Catherine G. Gitige
- Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania; (K.C.B.); (P.J.S.); (A.M.C.); (C.G.G.)
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro 25116, Tanzania; (N.G.C.); (B.T.M.)
- Kilimanjaro Clinical Research Institute, Moshi Kilimanjaro 25116, Tanzania
| | - Nyanda E. Ntinginya
- National Institute of Medical Research-Mbeya Medical Research Centre, Hospital Hill Road, Mbeya 53110, Tanzania;
| | - Jan-Willem C. Alffenaar
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW 2006, Australia;
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW 2145, Australia
- Westmead Hospital, Sydney, NSW 2145, Australia
| | - Ib C. Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, DK-1353 Copenhagen, Denmark; (I.C.B.); (T.L.); (D.L.C.)
| | - Troels Lillebaek
- Global Health Section, Department of Public Health, University of Copenhagen, DK-1353 Copenhagen, Denmark; (I.C.B.); (T.L.); (D.L.C.)
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, DK-2300 Copenhagen, Denmark
| | - Dirk L. Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, DK-1353 Copenhagen, Denmark; (I.C.B.); (T.L.); (D.L.C.)
| | - Kaushik L. Ramaiya
- Department of Internal Medicine, Hindu Manda Hospital, Ilala, Dar es Salaam 11104, Tanzania; (M.Z.A.); (K.L.R.)
| |
Collapse
|
6
|
Wen L, Shi L, Wan SS, Xu T, Zhang L, Zhou ZG. Changes in the balance of Th17/Treg cells and oxidative stress markers in patients with HIV‑associated pulmonary tuberculosis who develop IRIS. Exp Ther Med 2023; 25:271. [PMID: 37206552 PMCID: PMC10189753 DOI: 10.3892/etm.2023.11970] [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: 07/01/2022] [Accepted: 02/23/2023] [Indexed: 05/21/2023] Open
Abstract
Tuberculosis (TB) is the most common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV) infection and is one of the primary causes of death from AIDS. The increased accessibility to highly active antiretroviral therapy (HAART) has significantly improved the clinical outcome of patients with HIV infection. However, following ART, rapid restoration of the immune system leads to immune reconstitution inflammatory syndrome (IRIS). Oxidative stress and innate immunity play a role in TB-associated IRIS (TB-IRIS). The present study investigated the changes that occur in oxidative stress markers and T helper (Th)17/regulatory T (Treg) cell balance and their significance in IRIS patients with HIV-associated pulmonary TB. A total of 316 patients with HIV-associated pulmonary TB were treated with HAART and followed up regularly for 12 weeks. Those who developed IRIS were included in the IRIS group (n=60), while the remaining patients were included in the non-IRIS group (n=256). The changes in plasma oxidative stress markers superoxide dismutase (SOD) and malondialdehyde (MDA) were detected with the ELISA, and the ratio of Th17 to Treg cells in whole blood were analyzed before and after treatment through the flow cytometric assay. Following treatment, MDA and Th17 cells levels were significantly increased while SOD and Treg cells levels were decreased in the IRIS group (P<0.05) compared with before treatment. In the non-IRIS group, a non-significant decrease was observed in SOD levels (P>0.05), while the MDA levels significantly decreased compared with before treatment (P<0.05) and the Th17 and Treg cells levels were both significantly increased (P<0.05). After treatment, compared with the non-IRIS group, the IRIS group showed a significant increase in MDA and Th17 cells and decrease in SOD and Treg cells levels (P<0.05). In addition, Th17 cells levels were positively correlated with MDA but negatively correlated with SOD levels. Treg levels were negatively correlated with MDA and positively correlated with SOD levels (P<0.05). The area under the curve values of serum MDA and SOD, Th17 and Treg levels predicting the occurrence of IRIS were 0.738, 0.883, 0.722 and 0.719, respectively (P<0.05). These results indicated that the above parameters have certain diagnostic value for the occurrence of IRIS. The occurrence of IRIS in patients with HIV-associated pulmonary TB may be associated with oxidative stress and Th17/Treg cell imbalance.
Collapse
Affiliation(s)
- Long Wen
- Department of Respiratory and Critical Care Medicine, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, The First Hospital of Changsha, Changsha, Hunan 410000, P.R. China
| | - Lei Shi
- Department of Nursing, The Fourth Hospital of Changsha, Changsha, Hunan 410000, P.R. China
| | - Shan-Shan Wan
- Department of Respiratory and Critical Care Medicine, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, The First Hospital of Changsha, Changsha, Hunan 410000, P.R. China
| | - Tao Xu
- Department of Respiratory and Critical Care Medicine, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, The First Hospital of Changsha, Changsha, Hunan 410000, P.R. China
| | - Lei Zhang
- Department of Respiratory Medicine, Yicheng People's Hospital of Shandong, Zaozhuang, Shandong 277300, P.R. China
- Correspondence to: Dr Zhi-Guo Zhou, Department of Respiratory and Critical Care Medicine, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, The First Hospital of Changsha, 311 Yingpan Road, Kaifu, Changsha, Hunan 410000, P.R. China
| | - Zhi-Guo Zhou
- Department of Respiratory and Critical Care Medicine, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, The First Hospital of Changsha, Changsha, Hunan 410000, P.R. China
- Correspondence to: Dr Zhi-Guo Zhou, Department of Respiratory and Critical Care Medicine, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, The First Hospital of Changsha, 311 Yingpan Road, Kaifu, Changsha, Hunan 410000, P.R. China
| |
Collapse
|
7
|
Kalemeera F, Godman B, Stergachis A, Rennie T. Effect of tenofovir containing ART on renal function in patients with moderate/severe reduced creatinine clearance at baseline: A retrospective study at two referral hospitals in Namibia. Pharmacol Res Perspect 2022; 11:e00681. [PMID: 36585791 PMCID: PMC9803902 DOI: 10.1002/prp2.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 01/01/2023] Open
Abstract
Prescription of tenofovir disoproxil fumarate (TDF) for patients with baseline creatinine clearances (CrCl) <60 mL/min is said to increase risk of further decline in CrCl. Study objectives were to assess incidence of improvement and predictors thereof; to assess incidence of decline and transition to lower stages of CrCl; and comparison of declines between patients with a baseline CrCl < 60mL/min (group-I) and ≥ 60 mL/min (group-II). The study was retrospective, included patients 16 yrs or older who received TDF-containing ART. Improvement and decline were defined as ≥ 25% increase or decrease in CrCl, respectively. Binary logistic regression was performed to identify predictors of improvement. Groups I and II had 2862 and 7526 patients, respectively. In group-I, improvement in CrCl was observed in 40.1% (n = 1146), and was associated with stage IV of CrCl (adjusted Odds Ratio [aOR]=13.4 [95% CI: 6.7 - 26.9, P < .001]); male gender (aHR = 1.8 [95% CI: 1.5 - 2.2, P < .001]); and a poor HIV-status (aHR = 1.2 [95% CI: 1.0 - 1.4], P = .033). In group-I and group-II, respectively, decline occurred in 2.3% and 13.0%, (P < .001); transition to lower stages occurred in 1.0% and 25.2% (P < .001); and migration to stage IV CrCl occurred in 1.0% and 0.5% (P < .001). Improvement was more likely than decline in group-I patients. Although, group-I patients were more likely to experience new onset severe reduced CrCl than group-II patients, the proportions were extremely low. TDF should not be withheld from HIV-positive patients with a baseline CrCl < 60 mL/min.
Collapse
Affiliation(s)
| | - Brian Godman
- Strathclyde UniversityKarolinska InstituteSefako Makgatho University of Health SciencesGa‐RankuwaSouth Africa
| | - Andy Stergachis
- School of PharmacyUniversity of WashingtonSeattleWashingtonUSA
| | - Tim Rennie
- Faculty of Health SciencesUniversity of NamibiaWindhoekNamibia
| |
Collapse
|
8
|
Dass SA, Balakrishnan V, Arifin N, Lim CSY, Nordin F, Tye GJ. The COVID-19/Tuberculosis Syndemic and Potential Antibody Therapy for TB Based on the Lessons Learnt From the Pandemic. Front Immunol 2022; 13:833715. [PMID: 35242137 PMCID: PMC8886238 DOI: 10.3389/fimmu.2022.833715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/25/2022] [Indexed: 12/19/2022] Open
Abstract
2020 will be marked in history for the dreadful implications of the COVID-19 pandemic that shook the world globally. The pandemic has reshaped the normality of life and affected mankind in the aspects of mental and physical health, financial, economy, growth, and development. The focus shift to COVID-19 has indirectly impacted an existing air-borne disease, Tuberculosis. In addition to the decrease in TB diagnosis, the emergence of the TB/COVID-19 syndemic and its serious implications (possible reactivation of latent TB post-COVID-19, aggravation of an existing active TB condition, or escalation of the severity of a COVID-19 during TB-COVID-19 coinfection), serve as primary reasons to equally prioritize TB. On a different note, the valuable lessons learnt for the COVID-19 pandemic provide useful knowledge for enhancing TB diagnostics and therapeutics. In this review, the crucial need to focus on TB amid the COVID-19 pandemic has been discussed. Besides, a general comparison between COVID-19 and TB in the aspects of pathogenesis, diagnostics, symptoms, and treatment options with importance given to antibody therapy were presented. Lastly, the lessons learnt from the COVID-19 pandemic and how it is applicable to enhance the antibody-based immunotherapy for TB have been presented.
Collapse
Affiliation(s)
- Sylvia Annabel Dass
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Minden, Malaysia
| | - Venugopal Balakrishnan
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Minden, Malaysia
| | - Norsyahida Arifin
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Minden, Malaysia
| | - Crystale Siew Ying Lim
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Fazlina Nordin
- Tissue Engineering Centre (TEC), Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Gee Jun Tye
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Minden, Malaysia
| |
Collapse
|
9
|
Alao MA, Ibrahim OR, Chan YH. Clinical and Psychosocial Determinants of Patients with Tuberculosis/Human Immunodeficiency Virus Co-Infection: A Structural Equation Model Approach. Niger J Clin Pract 2022; 25:105-109. [PMID: 35046203 DOI: 10.4103/njcp.njcp_466_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Tuberculosis (TB)/human immunodeficiency virus (HIV) co-infection is a complex mesh of physical and psychosocial disorders that require a multimodal and multifaceted approach for improved outcomes. Aims This study determined the treatment outcomes of patients with TB/HIV co-infection and the clinico-psychosocial predictors of the disease over a 10-year period in resource-limited settings. Patients and Methods This study reviewed the 10-year retrospective treatment outcomes of patients with TB/HIV co-infection in a tertiary centre. The data were retrieved from the TB treatment registers and analyzed with STATA 16.0. The effects of latent constructs of high clinical severity, stigmatization, and family stress/burden on treatment outcomes were evaluated using a structural equation model. Results Of the 1,321 who met the inclusion criteria, 1,193 had sufficient data. The mean age of the patients was 38.2 ± 16.7 years. The treatment adherence rate over the 10 years was 93.8% (±6.8%) but successful treatment outcome was 75.5% (±8.1%). Stigmatism of TB/HIV infections was experienced by adults and males (β = 0.972; P < 0.001 β = 0.674; P < 0.001, β = -0.770; P < 0.001, respectively), non-adherent to treatment (β = -0.460; P < 0.001) clinical severity of illness (β = 0.940; P < 0.001), and being HIV negative (β = -0.770; P < 0.001). Family Stress/Burden was strongly affected by both Death (β = 1.000; P < 0.001) and higher Stigmatism (β = 0.602; P < 0.001). Clinical severity of illness significantly influenced both Death and Unsatisfactory outcomes (β = 0.207; P < 0.001, β = 0.203; P < 0.05, respectively). Non-Adherence led to potentially unsatisfactory outcome. Conclusion TB/HIV co-infection is a complex psychosocial disorder that is significantly and negatively impacted by social determinants of the disease. A holistic approach to treatment intervention that addresses the latent factors of stigmatization, family stress/burden, and high clinical severity is key to achieving a successful treatment outcome.
Collapse
Affiliation(s)
- M A Alao
- Department of Paediatrics, Bowen University Teaching Hospital, Ogbomoso, Oyo State; Bowen University College of Medicine Iwo, Osun State; University College Hospital Ibadan, Oyo State, Nigeria
| | - O R Ibrahim
- Department of Paediatrics, Federal Medical Centre, Kastina, Katsina State, Nigeria
| | - Y H Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
10
|
Liebenberg C, Luies L, Williams AA. Metabolomics as a Tool to Investigate HIV/TB Co-Infection. Front Mol Biosci 2021; 8:692823. [PMID: 34746228 PMCID: PMC8565463 DOI: 10.3389/fmolb.2021.692823] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/04/2021] [Indexed: 12/28/2022] Open
Abstract
The HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) and tuberculosis (TB) pandemics are perpetuated by a significant global burden of HIV/TB co-infection. The synergy between HIV and Mycobacterium tuberculosis (Mtb) during co-infection of a host is well established. While this synergy is known to be driven by immunological deterioration, the metabolic mechanisms thereof remain poorly understood. Metabolomics has been applied to study various aspects of HIV and Mtb infection separately, yielding insights into infection- and treatment-induced metabolic adaptations experienced by the host. Despite the contributions that metabolomics has made to the field, this approach has not yet been systematically applied to characterize the HIV/TB co-infected state. Considering that limited HIV/TB co-infection metabolomics studies have been published to date, this review briefly summarizes what is known regarding the HIV/TB co-infection synergism from a conventional and metabolomics perspective. It then explores metabolomics as a tool for the improved characterization of HIV/TB co-infection in the context of previously published human-related HIV infection and TB investigations, respectively as well as for addressing the gaps in existing knowledge based on the similarities and deviating trends reported in these HIV infection and TB studies.
Collapse
|
11
|
Padmapriyadarsini C, Sekar L, Reddy D, Chitra A, Poornagangadevi N, Selvaraj M, Bhavani PK, Mothi SN, Nandagopal K, Vennila S, Tamizhselvan M, Maheshmanisha J, Agarwal U, Rewari BB, Swaminathan S. Effectiveness of isoniazid preventive therapy on incidence of tuberculosis among HIV-infected adults in programme setting. Indian J Med Res 2021; 152:648-655. [PMID: 34145105 PMCID: PMC8224160 DOI: 10.4103/ijmr.ijmr_1582_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background & objectives: As India and other developing countries are scaling up isoniazid preventive therapy (IPT) for people living with HIV (PLHIV) in their national programmes, we studied the feasibility and performance of IPT in terms of treatment adherence, outcome and post-treatment effect when given under programmatic settings. Methods: A multicentre, prospective pilot study was initiated among adults living with HIV on isoniazid 300 mg with pyridoxine 50 mg after ruling out active tuberculosis (TB). Symptom review and counselling were done monthly during IPT and for six-month post-IPT. The TB incidence rate was calculated and risk factors were identified. Results: Among 4528 adults living with HIV who initiated IPT, 4015 (89%) successfully completed IPT. IPT was terminated in 121 adults (3%) due to grade 2 or above adverse events. Twenty five PLHIVs developed TB while on IPT. The incidence of TB while on IPT was 1.17/100 person-years (p-y) [95% confidence interval (CI) 0.8-1.73] as compared to TB incidence of 2.42/100 p-y (95% CI 1.90-3.10) during the pre-IPT period at these centres (P=0.017). The incidence of TB post-IPT was 0.64/100 p-y (95% CI 0.04-1.12). No single factor was significantly associated with the development of TB. Interpretation & conclusions: Under programmatic settings, completion of IPT treatment was high, adverse events minimal with good post-treatment protection. After ruling out TB, IPT should be offered to all PLHIVs, irrespective of their antiretroviral therapy (ART) status. Scaling-up of IPT services including active case finding, periodic counselling on adherence and re-training of ART staff should be prioritized to reduce the TB burden in this community.
Collapse
Affiliation(s)
- C Padmapriyadarsini
- Department of Clincial Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - L Sekar
- Department of Statistics, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Devarajulu Reddy
- Department of Clincial Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Anandha Chitra
- Government Rajaji Medical College & Hospital, Madurai, India
| | - N Poornagangadevi
- Department of Clincial Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - M Selvaraj
- ART Centre, Government Vellore Medical College & Hospital, Vellore, India
| | - P K Bhavani
- Department of Clincial Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - S N Mothi
- Paediatric ART Centre, Ashakirana Hospital, Mysuru, Karnataka, India
| | - K Nandagopal
- Nodal ART Centre, Government Kilpauk Medical College & Hospital, Chennai, India
| | - S Vennila
- ART Centre, Government Vellore Medical College & Hospital, Vellore, India
| | - M Tamizhselvan
- Department of Statistics, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | | | - Upasna Agarwal
- Nodal ART Centre, National Institute for Tuberculosis & Respiratory Diseases, New Delhi, India
| | - B B Rewari
- Care, Support & Treatment Division, National AIDS Control Organization, New Delhi, India
| | - Soumya Swaminathan
- Department of Clincial Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| |
Collapse
|
12
|
Tuberculosis Treatment Outcome in Patients with TB-HIV Coinfection in Kuala Lumpur, Malaysia. J Trop Med 2021; 2021:9923378. [PMID: 34194511 PMCID: PMC8181108 DOI: 10.1155/2021/9923378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis (TB) is a serious health threat to people living with human immunodeficiency virus (HIV). This study aimed to identify the characteristics, unsuccessful TB treatment rate, and determinants of unsuccessful TB treatment outcome among patients with TB-HIV coinfection in Kuala Lumpur. Methods This was a cross-sectional study. The data of all patients with TB-HIV in the federal territory of Kuala Lumpur from 2013 to 2017 were collected and reviewed. The data were retrieved from the national database (TB Information System) at the Kuala Lumpur Health Department from 1 March 2018 to 31 May 2018. Results Out of 235 randomly selected patients with TB-HIV, TB treatment outcome was successful in 57.9% (cured and completed treatment) and unsuccessful in 42.1% (died, failed, or lost to follow-up). Patients who did not receive DOTS (directly observed treatment, short course) (adjusted odds ratio: 21.71; 95% confidence interval: 5.36–87.94) and those who received shorter treatment duration of <6 months (aOR: 34.54; 95% CI: 5.97–199.93) had higher odds for unsuccessful TB treatment outcome. Conclusions Nearly half of the patients with TB-HIV had unsuccessful TB treatment outcome. Therefore, it is important to ensure that such patients receive DOTS and continuous TB treatment of >6 months. It is crucial to strengthen and widen the coverage of DOTS, especially among high-risk groups, in healthcare settings. Strict follow-up by healthcare providers is needed for patients with TB-HIV to gain treatment adherence and for better rates of successful TB treatment.
Collapse
|
13
|
Quinn CM, Poplin V, Kasibante J, Yuquimpo K, Gakuru J, Cresswell FV, Bahr NC. Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease. Life (Basel) 2020; 10:E262. [PMID: 33138069 PMCID: PMC7693460 DOI: 10.3390/life10110262] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 12/14/2022] Open
Abstract
Antiretroviral therapy (ART), while essential in combatting tuberculosis (TB) and HIV coinfection, is often complicated by the TB-associated immune reconstitution inflammatory syndrome (TB-IRIS). Depending on the TB disease site and treatment status at ART initiation, this immune-mediated worsening of TB pathology can take the form of paradoxical TB-IRIS, unmasking TB-IRIS, or CNS TB-IRIS. Each form of TB-IRIS has unique implications for diagnosis and treatment. Recently published studies have emphasized the importance of neutrophils and T cell subtypes in TB-IRIS pathogenesis, alongside the recognized role of CD4 T cells and macrophages. Research has also refined our prognostic understanding, revealing how the disease can impact lung function. While corticosteroids remain the only trial-supported therapy for prevention and management of TB-IRIS, increasing interest has been given to biologic therapies directly targeting the immune pathology. TB-IRIS, especially its unmasking form, remains incompletely described and more data is needed to validate biomarkers for diagnosis. Management strategies remain suboptimal, especially in the highly morbid central nervous system (CNS) form of the disease, and further trials are necessary to refine treatment. In this review we will summarize the current understanding of the immunopathogenesis, the presentation of TB-IRIS and the evidence for management recommendations.
Collapse
Affiliation(s)
- Carson M. Quinn
- School of Medicine, University of California, San Francisco, CA 94143, USA
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; (J.K.); (J.G.); (F.V.C.)
| | - Victoria Poplin
- Division of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, KS 66045, USA; (V.P.); (N.C.B.)
| | - John Kasibante
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; (J.K.); (J.G.); (F.V.C.)
| | - Kyle Yuquimpo
- Department of Medicine, University of Kansas, Kansas City, KS 66045, USA;
| | - Jane Gakuru
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; (J.K.); (J.G.); (F.V.C.)
| | - Fiona V. Cresswell
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; (J.K.); (J.G.); (F.V.C.)
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Medical Research Council, Uganda Virus Research Unit, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Nathan C. Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, KS 66045, USA; (V.P.); (N.C.B.)
| |
Collapse
|
14
|
Umumararungu T, Mukazayire MJ, Mpenda M, Mukanyangezi MF, Nkuranga JB, Mukiza J, Olawode EO. A review of recent advances in anti-tubercular drug development. Indian J Tuberc 2020; 67:539-559. [PMID: 33077057 DOI: 10.1016/j.ijtb.2020.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/24/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023]
Abstract
Tuberculosis is a global threat but in particular affects people from developing countries. It is thought that nearly a third of the population of the world live with its causative bacteria in a dormant form. Although tuberculosis is a curable disease, the chances of cure become slim as the disease becomes multidrug-resistant and the situation gets even worse as the disease becomes extensively drug-resistant. After approximately 5 decades without any new TB drug in the pipeline, there has been some good news in the recent years with the discovery of new drugs such as bedaquiline and delamanid as well as the discovery of new classes of anti-tubercular drugs. Some old drugs such as clofazimine, linezolid and many others which were not previously indicated for tuberculosis have been also repurposed for tuberculosis and they are performing well.
Collapse
Affiliation(s)
- Théoneste Umumararungu
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda.
| | - Marie Jeanne Mukazayire
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Matabishi Mpenda
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Marie Françoise Mukanyangezi
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Jean Bosco Nkuranga
- Department of Chemistry, School of Science, College of Science and Technology, University of Rwanda, Rwanda
| | - Janvier Mukiza
- Department of Mathematical Science and Physical Education, School of Education, College of Education, University of Rwanda, Rwanda
| | | |
Collapse
|
15
|
Edessa D, Sisay M, Dessie Y. Unfavorable outcomes to second-line tuberculosis therapy among HIV-infected versus HIV-uninfected patients in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2020; 15:e0237534. [PMID: 32797110 PMCID: PMC7428180 DOI: 10.1371/journal.pone.0237534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/28/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Drug resistance is a key obstacle to the global target set to end tuberculosis by 2030. Clinical complexities in drug-resistant tuberculosis and HIV-infection co-management could worsen outcomes of second-line anti-tuberculosis drugs. A comprehensive estimate for risks of unsuccessful outcomes to second-line tuberculosis therapy in HIV-infected versus HIV-uninfected patients is mandatory to address such aspects in segments of the target set. Therefore, this meta-analysis was aimed to estimate the pooled risk ratios of unfavorable outcomes to second-line tuberculosis therapy between HIV-infected and HIV-uninfected patients in sub-Saharan Africa. METHODS We conducted a literature search from PubMed/MEDLINE, EMBASE, SCOPUS and Google Scholar. We screened the retrieved records by titles and abstracts. Finally, we assessed eligibility and quality of full-text articles for the records retained by employing appraisal checklist of the Joanna Briggs Institute. We analyzed the data extracted from the included studies by using Review Manager Software, version 5.3 and presented our findings in forest and funnel plots. Protocol for this study was registered on PROSPERO (ID: CRD42020160473). RESULTS A total of 19 studies with 1,766 from 4,481 HIV-infected and 1,164 from 3,820 HIV-uninfected patients had unfavorable outcomes. The risk ratios we estimated between HIV-infected and HIV-uninfected drug-resistant tuberculosis patients were 1.18 (95% CI: 1.07-1.30; I2 = 48%; P = 0.01) for the overall unfavorable outcome; 1.50 (95% CI: 1.30-1.74) for death; 0.66 (95% CI: 0.38-1.13) for treatment failure; and 0.82 (95% CI: 0.74-0.92) for loss from treatment. Variable increased risks of unfavorable outcomes estimated for subgroups with significance in mixed-age patients (RR: 1.22; 95% CI: 1.10-1.36) and eastern region of sub-Saharan Africa (RR: 1.47; 95% CI: 1.23-1.75). CONCLUSIONS We found a higher risk of unfavorable treatment outcome in drug-resistant tuberculosis patients with death highly worsening in HIV-infected than in those HIV-uninfected patients. The risks for the unfavorable outcomes were significantly higher in mixed-age patients and in the eastern region of sub-Saharan Africa. Therefore, special strategies that reduce the risks of death should be discovered and implemented for HIV and drug-resistant tuberculosis co-infected patients on second-line tuberculosis therapy with optimal integration of the two programs in the eastern region of sub-Saharan Africa.
Collapse
Affiliation(s)
- Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Oromia, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Oromia, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Oromia, Ethiopia
| |
Collapse
|
16
|
Letang E, Ellis J, Naidoo K, Casas EC, Sánchez P, Hassan-Moosa R, Cresswell F, Miró JM, García-Basteiro AL. Tuberculosis-HIV Co-Infection: Progress and Challenges After Two Decades of Global Antiretroviral Treatment Roll-Out. Arch Bronconeumol 2020; 56:446-454. [PMID: 35373756 DOI: 10.1016/j.arbr.2019.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/02/2019] [Indexed: 06/14/2023]
Abstract
Despite wide antiretroviral scale-up during the past two decades resulting in declining new infections and mortality globally, HIV-associated tuberculosis remains as a major public health concern. Tuberculosis is the leading HIV-associated opportunistic infection and the main cause of death globally and, particularly, in resource-limited settings. Several challenges exist regarding diagnosis, global implementation of latent tuberculosis treatment, management of active tuberculosis, delivery of optimal patient-centered TB and HIV prevention and care in high burden countries. In this article we review the advances on pathogenesis, diagnosis, and treatment after nearly two decades of global roll-out of antiretroviral therapy and discuss the current challenges for the global control of tuberculosis-HIV co-infection.
Collapse
Affiliation(s)
- Emilio Letang
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Infectious Diseases Department, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain.
| | - Jayne Ellis
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Hospital for Tropical Diseases, University College London, London, UK
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
| | - Esther C Casas
- Southern Africa Medical Unit, Médecins sans Frontières, Cape Town, South Africa
| | - Paquita Sánchez
- Infectious Diseases Department, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain
| | - Razia Hassan-Moosa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
| | - Fiona Cresswell
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; MRC-UVRI-London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Jose M Miró
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alberto L García-Basteiro
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| |
Collapse
|
17
|
Lee GO, Comina G, Hernandez-Cordova G, Naik N, Gayoso O, Ticona E, Coronel J, Evans CA, Zimic M, Paz-Soldan VA, Gilman RH, Oberhelman R. Cough dynamics in adults receiving tuberculosis treatment. PLoS One 2020; 15:e0231167. [PMID: 32511248 PMCID: PMC7279573 DOI: 10.1371/journal.pone.0231167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/17/2020] [Indexed: 11/19/2022] Open
Abstract
Cough is a characteristic symptom of tuberculosis, is the main cause of transmission, and is used to assess treatment response. We aimed to identify the best measure of cough severity and characterize changes during initial tuberculosis therapy. We conducted a prospective cohort of recently diagnosed ambulatory adult patients with pulmonary tuberculosis in two tertiary hospitals in Lima, Peru. Pre-treatment and five times during the first two months of treatment, a vibrometer was used to capture 4-hour recordings of involuntary cough. A total of 358 recordings from 69 participants were analyzed using a computer algorithm. Total time spent coughing (seconds per hour) was a better predictor of microbiologic indicators of disease severity and treatment response than the frequency of cough episodes or cough power. Patients with prior tuberculosis tended to cough more than patients without prior tuberculosis, and patients with tuberculosis and diabetes coughed more than patients without diabetes co-morbidity. Cough characteristics were similar regardless of HIV co-infection and for drug-susceptible versus drug-resistant tuberculosis. Tuberculosis treatment response may be meaningfully assessed by objectively monitoring the time spent coughing. This measure demonstrated that cough was increased in patients with TB recurrence or co-morbid diabetes, but not because of drug resistance or HIV co-infection.
Collapse
Affiliation(s)
- Gwenyth O. Lee
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, United States of America
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Germán Comina
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, United States of America
| | - Gustavo Hernandez-Cordova
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, United States of America
| | - Nehal Naik
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Oscar Gayoso
- Pulmonology Department, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Eduardo Ticona
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, San Marcos, Peru
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo Lima, Mayo, Lima, Perú
| | - Jorge Coronel
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlton A. Evans
- Asociación Benéfica PRISMA, Lima, Perú
- Laboratory of Research and Development, Innovation For Health And Development (IFHAD), Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Mirko Zimic
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio de Bioinformática y Biología Molecular, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Valerie A. Paz-Soldan
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, United States of America
- Asociación Benéfica PRISMA, Lima, Perú
| | - Robert H. Gilman
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Asociación Benéfica PRISMA, Lima, Perú
- Department of International Health, Program in Global Disease Epidemiology and Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Richard Oberhelman
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, United States of America
| |
Collapse
|
18
|
Byashalira K, Mbelele P, Semvua H, Chilongola J, Semvua S, Liyoyo A, Mmbaga B, Mfinanga S, Moore C, Heysell S, Mpagama S. Clinical outcomes of new algorithm for diagnosis and treatment of Tuberculosis sepsis in HIV patients. Int J Mycobacteriol 2020; 8:313-319. [PMID: 31793499 DOI: 10.4103/ijmy.ijmy_135_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Despite effort to diagnose tuberculosis (TB) in the Human Immunodeficiency Virus (HIV) infected population, 45% of adults with HIV that had a previously unknown reason for death, demonstrated TB was the cause by autopsy examination. We aimed to assess the clinical outcomes of implementation a new algorithm for diagnosis and treatment of tuberculosis (TB) related sepsis among PLHIV presenting with life-threatening illness. Methods This study is a prospective cohort conducted in three-referral hospitals in Kilimanjaro, recruited 97 PLHIV from February through June 2018. Patients provided urine and sputum samples for testing lateral flow - lipoarabinomannan (LF-LAM) and Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assays, respectively. Anti-TB was prescribed to patients with positive LF-LAM or Xpert MTB/RIF or received broad-spectrum antibiotics but deteriorated. Results Of 97 patients, 84 (87%) provided urine and sputa, and 13 (13%) provided only urine. The mean age (95% confidence interval) was 40 (38-43) years and 52 (54%) were female. In 84 patients, LF-LAM increased TB detection from 26 (31%) by Xpert MTB/RIF to 41 (55%) by both tests. Of 97 patients, 69 (71%) prescribed anti-TB, 67% (46/69) and 33% (23/69) had definitive and probable TB respectively. Sixteen (16.5%) patients died, of which one died before treatment, 73% (11/15) died within 7 days of admission. The 30-day survival was similar in both treatment groups (log rank = 0.1574). Mortality was significantly higher among hospitalized patients compared to outpatients (P ≤ 0.027). Conclusion Implementation of new algorithm increased TB case detection in patients that could have been missed by Xpert MTB/RIF assay. Survival of PLHIV with confirmed or probable TB was comparable to those of PLHIV that were treated with broad-spectrum antibiotics alone. Further work should focus on the optimal timing and content of the immediate antimicrobial regimen for sepsis among PLHIV in TB-endemic settings.
Collapse
Affiliation(s)
- Kenneth Byashalira
- Kilimanjaro Christian Medical University College; Kibong'oto Infectious Diseases Hospital, Tanzania
| | | | - Hadija Semvua
- Kilimanjaro Christian Medical University College; Kilimanjaro Clinical Research Institute, Tanzania
| | - Jaffu Chilongola
- Kilimanjaro Christian Medical University College; Kilimanjaro Clinical Research Institute, Tanzania
| | - Seleman Semvua
- Kilimanjaro Christian Medical University College, Tanzania
| | | | - Blandina Mmbaga
- Kilimanjaro Christian Medical University College; Kilimanjaro Clinical Research Institute, Tanzania
| | - Sayoki Mfinanga
- National Institute for Medical Research-Muhimbili Medical Research Centre, Tanzania
| | - Christopher Moore
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Scott Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Stellah Mpagama
- Kilimanjaro Christian Medical University College; Kibong'oto Infectious Diseases Hospital, Tanzania
| |
Collapse
|
19
|
Mugusi S, Habtewold A, Ngaimisi E, Amogne W, Yimer G, Minzi O, Makonnen E, Sudfeld C, Burhenne J, Aklillu E. Impact of Population and Pharmacogenetics Variations on Efavirenz Pharmacokinetics and Immunologic Outcomes During Anti-Tuberculosis Co-Therapy: A Parallel Prospective Cohort Study in Two Sub-Sahara African Populations. Front Pharmacol 2020; 11:26. [PMID: 32116703 PMCID: PMC7019112 DOI: 10.3389/fphar.2020.00026] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/10/2020] [Indexed: 01/02/2023] Open
Abstract
Efavirenz-based combination antiretroviral-therapy (cART) is the recommended regimen during tuberculosis (TB) therapy. In a multi-national parallel prospective-cohort study, we investigated the impact of population and pharmacogenetic variations for efavirenz pharmacokinetics, auto-induction, and immunologic outcome during antituberculosis treatment. A total of 921 treatment-naïve HIV patients with (196 Ethiopians and 231 Tanzanians) or without TB co-infection (285 Ethiopians and 209 Tanzanians) were enrolled and treated with efavirenz-based cART. TB-HIV patients started rifampicin-based anti-TB therapy 4 weeks before cART. Efavirenz plasma concentrations were measured on the 4th and 16th weeks of cART. Genotyping for CYP2B6, CYP3A5, ABCB1, UGT2B7, and SLCO1B1 was done. CD4 cells-count was measured at baseline, 12th, 24th, and 48th weeks of cART. Among HIV-only cohort, plasma efavirenz concentration and median CD4 cell count were significantly higher in Tanzanians than Ethiopians, and both CYP2B6 genotype and population-variation were significant predictors of efavirenz plasma concentration. Within-population analyses indicated a pronounced efavirenz autoinduction in Tanzanians as reflected by a significant decrease of plasma efavirenz concentration over time (p = 0.0001), but not in Ethiopians. Among TB-HIV cohort, there were no significant between-population differences in plasma efavirenz concentrations or CD4 cell-recovery, and CYP2B6 genotype but not population-variation was a significant predictor of efavirenz plasma exposure. In Tanzanian patients, short-term anti-TB co-treatment significantly reduced the mean plasma efavirenz concentration in CYP2B6*1/*1 genotype at week-4 (p = 0.005), but not at week-16 of cART. In Ethiopian patients, anti-TB cotreatment increased the mean plasma efavirenz concentration among CYP2B6*6 carriers at week-4 (p = 0.003) and week-16 (p = 0.035) of cART. In general, long-term anti-TB co-treatment increased plasma efavirenz concentration at week 16 of cART in both Ethiopians and Tanzanians being higher in CYP2B6*6/*6 > *1/*6 > *1/*1 genotypes. In TB-HIV patients, baseline body mass index (BMI), viral load, and WHO clinical-stage but not genotype, population-variation, or efavirenz concentration were significant predictors of immunologic outcome at week-48. In summary efavirenz auto-induction, pharmacokinetics, and the immunologic outcome are influenced by population-variation, anti-TB co-medication, and CYP2B6 genotype. CYP2B6 genotype is a significant predictor of efavirenz plasma exposure regardless of population-variation or antituberculosis co-treatment, but population-variation is insignificant during antituberculosis treatment. CYP2B6 genotype, population, and geographic differences need to be considered for efavirenz dosage-optimization.
Collapse
Affiliation(s)
- Sabina Mugusi
- Department of Clinical Pharmacology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Abiy Habtewold
- Department of Pharmaceutical Sciences, School of Pharmacy, William Carey University, Hattiesburg, MS, United States
| | - Eliford Ngaimisi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wondwossen Amogne
- Department of Internal Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Yimer
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Omary Minzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eyasu Makonnen
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Christopher Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Jürgen Burhenne
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
20
|
Almeida Santos J, Duarte R, Nunes C. Tuberculin skin test and predictive host factors for false-negative results in patients with pulmonary and extrapulmonary tuberculosis. CLINICAL RESPIRATORY JOURNAL 2020; 14:541-548. [PMID: 32052551 DOI: 10.1111/crj.13166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Tuberculin skin test (TST) has been the standard test for screening for Mycobacterium tuberculosis infection for decades. Identifying persons with latent tuberculosis infection (LTBI) is crucial, as they constitute a reservoir that sustains the global tuberculosis (TB) epidemic. However, different factors, such as HIV infection, can lower the sensitivity of the test. OBJECTIVES The aim of this study was to determine the TST sensitivity in active TB patients and to ascertain risk factors that could be associated with false-negative results. METHODS Retrospective cohort study of all active TB notifications with a TST result (n = 8833), from 2008 to 2015. TST results were interpreted using a 5 mm and 10 mm cutoff. Bivariate and multivariate logistic regression analysis were used to evaluate the association of sociodemographic and clinical factors with false-negative TST results and to develop predictive risk models. RESULTS TST presented an overall sensitivity of 63.8% (5 mm) and 56.1% (10 mm). HIV infection was the risk factor with the strongest association with false-negative results (aOR 4.65-5 mm; aOR 5.05-10 mm). Other factors such as chronic renal failure (CRF) (aOR 1.55-5 mm; aOR 1.73-10 mm), alcohol abuse (aOR 1.52-5 mm; aOR 1.31-10 mm), drug abuse (aOR 1.90-5 mm; aOR 1.76-10 mm) or age ≥65 years (OR 1.69-5 mm and 10 mm) were also associated with a probability of false-negative results. CONCLUSION These results highlight the importance of knowing which factors influence TST results, such as HIV status, substance abuse or age, thus improving its usefulness as a screening method for LTBI.
Collapse
Affiliation(s)
- João Almeida Santos
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Raquel Duarte
- Centro Diagnóstico Pneumológico de Vila Nova de Gaia, Vila Nova de Gaia, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Carla Nunes
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| |
Collapse
|
21
|
Petruccioli E, Chiacchio T, Navarra A, Vanini V, Cuzzi G, Cimaglia C, Codecasa LR, Pinnetti C, Riccardi N, Palmieri F, Antinori A, Goletti D. Effect of HIV-infection on QuantiFERON-plus accuracy in patients with active tuberculosis and latent infection. J Infect 2020; 80:536-546. [PMID: 32097688 DOI: 10.1016/j.jinf.2020.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/31/2020] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE HIV-infection increases the risk to progress to active-tuberculosis (TB). Detection of latent TB infection (LTBI) is needed to eventually propose preventive-therapy and reduce TB reservoir. QuantiFERON-TB Plus (QFT-Plus)-test identifies LTBI. Currently, only two studies on QFT-Plus accuracy in HIV-infected-population are available in high TB-endemic-countries. Therefore we aimed to evaluate the effect of HIV-infection on QFT-Plus accuracy to detect LTBI in a low TB-endemic-country. METHODS We enrolled 465 participants, among the 167 HIV-infected-persons: 32 with active-TB (HIV-TB), 45 remote-LTBI (HIV-LTBI) and 90 at low M. tuberculosis (Mtb)-infection risk. Among the 298 HIV-uninfected-persons: 170 with active-TB, 76 recent-LTBI, 34 remote-LTBI and 18 with low Mtb-infection risk. RESULTS QFT-Plus sensitivity was similar in TB regardless of HIV-status. CD4-count did not influence the distribution of IFN-γ values in HIV-TB and HIV-LTBI. Moreover HIV-LTBI and HIV-uninfected remote LTBI had a similar proportion of results in the uncertain range (IFNγ ≥0.2 ≤ 0.7 IU/ml) differently from those LTBI-persons reporting recent-exposure (p = 0.016). Cytometry results demonstrated that CD8-response was similar in HIV-infected- and -uninfected-persons whereas CD4-response was impaired in HIV-infected-persons (p = 0.011). CONCLUSIONS HIV-infection does not affect QFT-Plus response in active-TB, whereas the time of exposure influences the proportion of uncertain-results in LTBI.
Collapse
Affiliation(s)
- Elisa Petruccioli
- Translational Research Unit, Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Via Portuense 292, 00149 Rome, Italy
| | - Teresa Chiacchio
- Translational Research Unit, Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Via Portuense 292, 00149 Rome, Italy
| | - Assunta Navarra
- Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI) IRCCS, Italy
| | - Valentina Vanini
- Translational Research Unit, Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Via Portuense 292, 00149 Rome, Italy
| | - Gilda Cuzzi
- Translational Research Unit, Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Via Portuense 292, 00149 Rome, Italy
| | - Claudia Cimaglia
- Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI) IRCCS, Italy
| | - Luigi Ruffo Codecasa
- Regional TB Reference Centre, Istituto Villa Marelli, Ospedale Niguarda, Milan, Italy; StopTB Italia Onlus, Milan, Italy
| | - Carmela Pinnetti
- Department of Clinical and Clinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI) IRCCS, Italy
| | - Niccolò Riccardi
- Infectious Diseases and Tropical Medicine Centre, IRCCS Sacro Cuore Don Calabria Hospital (Negrar, Verona, Italy), Italy; StopTB Italia Onlus, Milan, Italy
| | - Fabrizio Palmieri
- Department of Clinical and Clinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI) IRCCS, Italy
| | - Andrea Antinori
- Department of Clinical and Clinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI) IRCCS, Italy
| | - Delia Goletti
- Translational Research Unit, Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Via Portuense 292, 00149 Rome, Italy.
| |
Collapse
|
22
|
Letang E, Ellis J, Naidoo K, Casas EC, Sánchez P, Hassan-Moosa R, Cresswell F, Miró JM, García-Basteiro AL. Tuberculosis-HIV Co-Infection: Progress and Challenges After Two Decades of Global Antiretroviral Treatment Roll-Out. Arch Bronconeumol 2020. [PMID: 31932150 DOI: 10.1016/j.arbres.2019.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite wide antiretroviral scale-up during the past two decades resulting in declining new infections and mortality globally, HIV-associated tuberculosis remains as a major public health concern. Tuberculosis is the leading HIV-associated opportunistic infection and the main cause of death globally and, particularly, in resource-limited settings. Several challenges exist regarding diagnosis, global implementation of latent tuberculosis treatment, management of active tuberculosis, delivery of optimal patient-centered TB and HIV prevention and care in high burden countries. In this article we review the advances on pathogenesis, diagnosis, and treatment after nearly two decades of global roll-out of antiretroviral therapy and discuss the current challenges for the global control of tuberculosis-HIV co-infection.
Collapse
Affiliation(s)
- Emilio Letang
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Infectious Diseases Department, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain.
| | - Jayne Ellis
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Hospital for Tropical Diseases, University College London, London, UK
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
| | - Esther C Casas
- Southern Africa Medical Unit, Médecins sans Frontières, Cape Town, South Africa
| | - Paquita Sánchez
- Infectious Diseases Department, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain
| | - Razia Hassan-Moosa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
| | - Fiona Cresswell
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; MRC-UVRI-London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Jose M Miró
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alberto L García-Basteiro
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| |
Collapse
|
23
|
Pedromonico Arrym M, Martins Alves PC, Virginello Castelhano M, Nitsch Mazzola T, Muller Banzato Pinto de Lemos R, Zaccariotto TR, Levy CE, Guimarães F, Nolasco da Silva MT. Preservation of cytotoxic granule production in response to mycobacterial antigens by T-lymphocytes from vertically HIV-infected Brazilian youth on effective combined antiretroviral therapy. Braz J Infect Dis 2019; 23:151-159. [PMID: 31271732 PMCID: PMC9428219 DOI: 10.1016/j.bjid.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/30/2019] [Accepted: 06/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background HIV infection harms adaptive cellular immunity mechanisms. Long-term virological control by combined antiretroviral therapy (cART) reduces the risk of mycobacterial infections. Thus, we aimed to study cellular responses to mycobacterial antigens in 20 HIV-infected adolescents with at least one year of virological control (HIV-RNA <40 copies/mL) and 20 healthy adolescents. Methods We evaluated CD8 and γδ T-cell degranulation by measurement of CD107a membrane expression after stimulation with lysates from BCG (10 μg/mL) and H37RA Mycobacterium tuberculosis (Mtb, 10 μg/mL). Immune activation and antigen-presenting ability were also assessed by determination of HLA-DR, CD80, and CD86 markers. Results TCR γδ T-cell CD107a expression was similar between groups in response to mycobacterial antigens, and lower in the HIV-infected group in response to mitogen. Higher baseline HLA-DR expression and lower mycobacterial-stimulated expression was found within the HIV-infected group. Conclusions Similar degranulation in stimulated CD8+ and TCR γδ T-cells from HIV-infected adolescents, when compared to healthy controls suggests long-term immunological preservation with immune reconstitution under successful cART. However, differences in HLA-DR expression may represent ongoing inflammation and lower specific responses in HIV-infected youth. These features may be relevant in the context of the precocity and severity of vertically acquired HIV infection.
Collapse
Affiliation(s)
- Mauro Pedromonico Arrym
- State University of Campinas, Faculty of Medical Sciences, Laboratory of Translational Research in Child and Adolescent Health, Center for Investigation in Pediatrics, Campinas, SP, Brazil
| | - Paulo César Martins Alves
- State University of Campinas, Faculty of Medical Sciences, Laboratory of Translational Research in Child and Adolescent Health, Center for Investigation in Pediatrics, Campinas, SP, Brazil
| | - Mariana Virginello Castelhano
- State University of Campinas, Faculty of Medical Sciences, Laboratory of Translational Research in Child and Adolescent Health, Center for Investigation in Pediatrics, Campinas, SP, Brazil
| | - Taís Nitsch Mazzola
- State University of Campinas, Center for Molecular Biology and Genetical Engineering, Campinas, SP, Brazil
| | | | - Tânia Regina Zaccariotto
- State University of Campinas Clinics Hospital, Clinical Pathology Laboratory, Campinas, SP, Brazil
| | - Carlos Emilio Levy
- State University of Campinas Clinics Hospital, Clinical Pathology Laboratory, Campinas, SP, Brazil
| | - Fernando Guimarães
- State University of Campinas, Center for Integral Attention to Women's Health, SP, Brazil
| | - Marcos Tadeu Nolasco da Silva
- State University of Campinas, Faculty of Medical Sciences, Laboratory of Translational Research in Child and Adolescent Health, Center for Investigation in Pediatrics, Campinas, SP, Brazil.
| |
Collapse
|
24
|
Mukonzo J, Aklillu E, Marconi V, Schinazi RF. Potential drug-drug interactions between antiretroviral therapy and treatment regimens for multi-drug resistant tuberculosis: Implications for HIV care of MDR-TB co-infected individuals. Int J Infect Dis 2019; 83:98-101. [PMID: 30991140 PMCID: PMC7700887 DOI: 10.1016/j.ijid.2019.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/15/2019] [Accepted: 04/06/2019] [Indexed: 02/07/2023] Open
Abstract
HIV-positive TB co-infected patients are at increased risk of multidrug-resistant (MDR)-TB compared to HIV-negative patients. Co-treatment of MDR-TB and HIV is common particularly in Sub-Saharan Africa where the co-morbidity is endemic. We discuss potential cellular metabolic pathway-mediated drug-drug interactions and the possible effect on HIV treatment outcomes of commonly prescribed antiretroviral therapy.
Collapse
Affiliation(s)
- Jackson Mukonzo
- Department of Pharmacology & Therapeutics, Makerere University College of Health Sciences Kampala, Uganda.
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory medicine, Karolinska Institutet, Karolinska University Hospital-Huddinge, Stockholm, Sweden
| | - Vincent Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Raymond F Schinazi
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| |
Collapse
|
25
|
Migliori GB, Centis R, D'Ambrosio L, Silva DR, Rendon A. International collaboration among medical societies is an effective way to boost Latin American production of articles on tuberculosis. ACTA ACUST UNITED AC 2019; 45:e20180420. [PMID: 31038653 PMCID: PMC6733746 DOI: 10.1590/1806-3713/e20180420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/10/2019] [Indexed: 01/02/2023]
Abstract
Objective: Most studies of tuberculosis originate from high-income countries with a low incidence of tuberculosis. A review of the scientific production on tuberculosis in Latin American countries, most of which are low- or middle-income countries (some with high or intermediate tuberculosis incidence rates), would improve the understanding of public health challenges, clinical needs, and research priorities. The aims of this systematic review were to determine what has been published recently in Latin America, to identify the leading authors involved, and to quantify the impact of international collaborations. Methods: We used PubMed to identify relevant manuscripts on pulmonary tuberculosis (PTB), drug-resistant tuberculosis (DR-TB), or multidrug-resistant tuberculosis (MDR-TB), published between 2013 and 2018. We selected only studies conducted in countries with an annual tuberculosis incidence of ≥ 10,000 reported cases and an annual MDR-TB incidence of ≥ 300 estimated cases, including Brazil, Peru, Mexico, Colombia, and Argentina. Articles were stratified by country, type, and topic. Results: We identified as eligible 395 studies on PTB and 188 studies on DR/MDR-TB-of which 96.4% and 96.8%, respectively, were original studies; 35.5% and 32.4%, respectively, had an epidemiological focus; and 52.7% and 36.2%, respectively, were conducted in Brazil. The recent Latin American Thoracic Association/European Respiratory Society/Brazilian Thoracic Association collaborative project boosted the production of high-quality articles on PTB and DR/MDR-TB in Latin America. Conclusions: Most of the recent Latin American studies on tuberculosis were conducted in Brazil, Mexico, or Peru. Collaboration among medical societies facilitates the production of scientific papers on tuberculosis. Such initiatives are in support of the World Health Organization call for intensified research and innovation in tuberculosis.
Collapse
Affiliation(s)
- Giovanni Battista Migliori
- . Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia
| | - Rosella Centis
- . Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia
| | | | - Denise Rossato Silva
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Adrian Rendon
- . Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias - CIPTIR - Hospital Universitario de Monterrey, Universidad Autónoma de Nuevo León -UANL - Monterrey, México
| |
Collapse
|
26
|
Castro SDS, Scatena LM, Miranzi A, Miranzi Neto A, Nunes AA. Characteristics of cases of tuberculosis coinfected with HIV in Minas Gerais State in 2016. Rev Inst Med Trop Sao Paulo 2019; 61:e21. [PMID: 30970049 PMCID: PMC6466842 DOI: 10.1590/s1678-9946201961021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/14/2019] [Indexed: 11/29/2022] Open
Abstract
This study aimed to characterize the cases of tuberculosis (TB) co-infected with
the human immunodeficiency virus (HIV) in Minas Gerais State, Brazil, after the
notification sheet modification, and to verify the association between the new
variables and the treatment outcome. It is an analytical cross-sectional study
with TB/HIV cases notified in the year 2016 to the Brazilian Information System
for Notifiable Diseases (Sistema de Informação de Agravos de
Notificação). Descriptive statistics, chi-square test, and multiple
correspondence analysis were performed to verify the association between the
outcome, ageand associated diseases. Of the 180 cases, most were male (75.6%)
between 30 and 49 years old (63.3%), mixed ethnicity (black and white) (49.4%),
94.4% had the Acquired Immunodeficiency Syndrome (AIDS) and 60.6% had pulmonary
TB. The molecular test was not performed at the time of diagnosis in 70.5% of
the cases. Homeless people (4.4%) and prisoners (3.9%) featured prominently
among the special populations. People between 40 and 49 years old without
concurrent diseases were cured in 40.0% of the cases; 18.9% abandoned the
treatment due to smoking, drug abuse and mental illness in the age group between
20 and 29 years old. The deaths were associated with the age group between 30
and 39 years old and the occurrence of AIDS. The results have shown that the
groups considered vulnerable (drug users, smokers and people with mental
illness) abandoned the treatment, the notification upon death from AIDS in
adults was late and some treatments were inadequate. The epidemiological
surveillance, prevention and assistance strategies towards cases of TB/HIV must
be improved in order to achieve the goal of the Brazilian National Plan to end
Tuberculosis as a Public Health Problem until 2035 in the state.
Collapse
Affiliation(s)
- Sybelle de Souza Castro
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Programa de Pós-Graduação Strictu Sensu em Saúde na Comunidade, Ribeirão Preto, São Paulo, Brazil.,Universidade Federal do Triângulo Mineiro, Departamento de Saúde Coletiva, Programa de Pós-Graduação Strictu Sensu em Atenção à Saúde, Uberaba, Minas Gerais, Brazil
| | - Lúcia Marina Scatena
- Universidade Federal do Triângulo Mineiro, Departamento de Saúde Coletiva, Programa de Pós-Graduação Strictu Sensu em Inovação Tecnológica, Uberaba, Minas Gerais, Brazil
| | - Alfredo Miranzi
- Universidade de Uberaba, Faculdade de Odontologia, Uberaba, Minas Gerais, Brazil
| | - Almir Miranzi Neto
- Faculdade Alfredo Nasser, Faculdade de Medicina, Aparecida de Goiânia, Goiás, Brazil
| | - Altacílio Aparecido Nunes
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Programa de Pós-Graduação Strictu Sensu em Saúde na Comunidade, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
27
|
Jiamsakul A, Lee MP, Nguyen KV, Merati TP, Cuong DD, Ditangco R, Yunihastuti E, Ponnampalavanar S, Zhang F, Kiertiburanakul S, Avihingasanon A, Ng OT, Sim BLH, Wong WW, Ross J, Law M. Socio-economic status and risk of tuberculosis: a case-control study of HIV-infected patients in Asia. Int J Tuberc Lung Dis 2019; 22:179-186. [PMID: 29506614 DOI: 10.5588/ijtld.17.0348] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Tuberculosis (TB) is the most common human immunodeficiency virus (HIV) related opportunistic infection and cause of acquired immune-deficiency syndrome related death. TB often affects those from a low socio-economic background. OBJECTIVE To assess the socio-economic determinants of TB in HIV-infected patients in Asia. DESIGN This was a matched case-control study. HIV-positive, TB-positive cases were matched to HIV-positive, TB-negative controls according to age, sex and CD4 cell count. A socio-economic questionnaire comprising 23 questions, including education level, employment, housing and substance use, was distributed. Socio-economic risk factors for TB were analysed using conditional logistic regression analysis. RESULTS A total of 340 patients (170 matched pairs) were recruited, with 262 (77.1%) matched for all three criteria. Pulmonary TB was the predominant type (n = 115, 67.6%). The main risk factor for TB was not having a university level education (OR 4.45, 95%CI 1.50-13.17, P = 0.007). Burning wood or coal regularly inside the house and living in the same place of origin were weakly associated with TB diagnosis. CONCLUSIONS These data suggest that lower socio-economic status is associated with an increased risk of TB in Asia. Integrating clinical and socio-economic factors into HIV treatment may help in the prevention of opportunistic infections and disease progression.
Collapse
Affiliation(s)
- A Jiamsakul
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - M-P Lee
- Queen Elizabeth Hospital, Hong Kong, SAR China
| | - K V Nguyen
- National Hospital for Tropical Diseases, Hanoi, Viet Nam
| | - T P Merati
- Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
| | | | - R Ditangco
- Research Institute for Tropical Medicine, Manila, The Philippines
| | - E Yunihastuti
- Working Group on AIDS, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - S Ponnampalavanar
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - F Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - S Kiertiburanakul
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok
| | - A Avihingasanon
- HIV-Netherlands Australia Thailand Research Collaboration, The Thai Red Cross AIDS Research Centre and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - O T Ng
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - B L H Sim
- Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - W-W Wong
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - J Ross
- Therapeutics Research, Education, and AIDS Training in Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - M Law
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
28
|
Owiti P, Onyango D, Momanyi R, Harries AD. Screening and testing for tuberculosis among the HIV-infected: outcomes from a large HIV programme in western Kenya. BMC Public Health 2019; 19:29. [PMID: 30621655 PMCID: PMC6323798 DOI: 10.1186/s12889-018-6334-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 12/17/2018] [Indexed: 01/07/2023] Open
Abstract
Background People living with HIV (PLHIV) are at increased risk of tuberculosis (TB). TB is also the leading opportunistic infection contributing to about one-third of deaths in this population. The World Health Organization recommends regular screening for TB in PLHIV. Those identified to have any TB-related symptoms are investigated and treated if diagnosed with TB. We sought to evaluate outcomes of intensified case finding and factors associated with undesirable screening for TB in a large HIV programme in western Kenya. Methods We conducted a retrospective study using routine programme data from the AMPATH HIV electronic medical records database for PLHIV in care between 2015 and 2016. Screening for TB was assessed by the recorded presence of cough ≥2 weeks, fever, night sweats, unintentional weight loss, chest pain and/or breathlessness. Undesirable screening was defined as being screened in < 90% of patient clinical encounters. Data were analyzed by encounters and per-patient. Factors associated with undesirable screening were analyzed using log-binomial regression and presented as relative risks. Results There were 90,454 PLHIV, 65% females, median age 40 years, median follow-up time of 1.5 years. Total encounters were 683,898, of which screening for TB was recorded in 87%. 1424 (1.6%) PLHIV were not screened at all during the study period. 44% (95% CI: 43.6–44.3) of PLHIV were screened in < 90% of their clinical encounters (undesirable screening). TB-related symptoms were reported in 0.7% of screened encounters, while in 96% of PLHIV, no symptoms were reported. Overall, in 8% of symptomatic encounters sputum microscopy and/or chest radiography results were recorded. 92% of PLHIV did not have TB-related laboratory results recorded for all their symptomatic encounters. Factors which increased the risks of undesirable screening included: attendance at paediatric clinics (aRR: 1.27, 95% CI: 1.20–1.34), being on antiretroviral therapy (aRR: 1.16, 95% CI: 1.13–1.18), having more clinical encounters (aRR: 1.04, 95% CI: 1.04–1.04), and higher patient volumes in a clinic. Conclusions There were missed opportunities for screening and testing for TB. Screening was reduced by being on ART, having increased patient-encounters, the clinic setup, and by high patient volumes. HIV programmes should focus on quality of TB care in HIV clinics.
Collapse
Affiliation(s)
- Philip Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. .,International Union Against Tuberculosis and Lung Disease, Paris, France. .,National Tuberculosis, Leprosy and Lung Disease Programme, Nairobi, Kenya.
| | | | | | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
29
|
Magis-Escurra C, Carvalho ACC, Kritski AL, Girardi E. Tuberculosis and comorbidities. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10022017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
30
|
Kumarasamy N, Poongulali S, Beulah FE, Akite EJ, Ayuk LN, Bollaerts A, Demoitié MA, Jongert E, Ofori-Anyinam O, Van Der Meeren O. Long-term safety and immunogenicity of the M72/AS01E candidate tuberculosis vaccine in HIV-positive and -negative Indian adults: Results from a phase II randomized controlled trial. Medicine (Baltimore) 2018; 97:e13120. [PMID: 30407329 PMCID: PMC6250513 DOI: 10.1097/md.0000000000013120] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess the long-term safety and immunogenicity of the M72/ Adjuvant System (AS01E) candidate tuberculosis (TB) vaccine up to 3 years post-dose 2 (Y3) in human immunodeficiency virus (HIV)-positive (HIV+) and HIV-negative (HIV-) Indian adults. METHODS This phase II, double-blind, randomised, controlled clinical trial (NCT01262976) was conducted at YRG CARE Medical Centre, in Chennai, India, between January 2011 and June 2015.Three cohorts (HIV+ participants stable on antiretroviral therapy [ART; HIV+ART+], HIV+ ART-naïve [HIV+ART-], and HIV- participants) were randomised (1:1) to receive 2 doses of M72/AS01E (M72/AS01E groups) or saline (control groups) 1 month apart and were followed up toY3. Latent TB infection was assessed at screening using an interferon-gamma (IFN-γ) release assay (IGRA). Safety and immunogenicity results up to Y1 post-vaccination were reported elsewhere. Here, we report serious adverse events (SAEs), humoral and cell-mediated immune (CMI) responses to M72 recorded at Y2 and Y3. RESULTS Of 240 enrolled and vaccinated participants, 214 completed the long-term follow-up part of the study.In addition to SAEs previously described, between Y1 and Y2 1 M72/AS01E recipient in the HIV+ART+ cohort reported 2 SAEs (sinus cavernous thrombosis and gastroenteritis) that were not considered as causally related to the study vaccine.Vaccination elicited persistent humoral immune responses against M72. At Y3, seropositivity rates were 97.1%, 66.7%, and 97.3% and geometric mean concentrations (GMCs) were 22.0 ELISA units (EU)/mL, 4.9 EU/mL, and 24.3 EU/mL in the HIV+ART+, HIV+ART-, and HIV- cohorts, respectively. Humoral immune response was lowest in the HIV+ART- cohort.In M72/AS01E recipients, no notable decrease in the frequency of M72-specific CD4 T-cells expressing ≥2 immune markers among interleukin-2 (IL-2), IFN-γ, tumour necrosis factor alpha (TNF-α) and CD40 ligand (CD40L) was observed at Y3 post-vaccination. Median values (interquartile range) of 0.35% (0.13-0.49), 0.05% (0.01-0.10), and 0.15% (0.09-0.22) were recorded in the HIV+ART+, HIV+ART- and HIV- cohorts, respectively. CD4 T-cell response was lowest in the HIV+ART- cohort.No CD8 T-cell response was observed. CONCLUSION The cellular and humoral immune responses induced by M72/AS01E in HIV+ and HIV- adults persisted up to Y3 post-vaccination. No safety concerns were raised regarding administration of M72/AS01E to HIV+ adults. CLINICAL TRIAL REGISTRATION NCT01262976 (www.clinicaltrials.gov).
Collapse
Affiliation(s)
- Nagalingeswaran Kumarasamy
- YRG CARE Medical Centre (YR Gaitonde Centre for AIDS Research and Education), Voluntary Health Services Campus, Taramani, Chennai, India
| | - Selvamuthu Poongulali
- YRG CARE Medical Centre (YR Gaitonde Centre for AIDS Research and Education), Voluntary Health Services Campus, Taramani, Chennai, India
| | - Faith Esther Beulah
- YRG CARE Medical Centre (YR Gaitonde Centre for AIDS Research and Education), Voluntary Health Services Campus, Taramani, Chennai, India
| | | | | | | | | | | | | | | |
Collapse
|
31
|
MARTINI M, BESOZZI G, BARBERIS I. The never-ending story of the fight against tuberculosis: from Koch's bacillus to global control programs. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2018; 59:E241-E247. [PMID: 30397682 PMCID: PMC6196368 DOI: 10.15167/2421-4248/jpmh2018.59.3.1051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 08/29/2018] [Indexed: 11/24/2022]
Abstract
Tuberculosis (TB) is one of the oldest diseases known to affect humanity, and is still a major public health problem. It is caused by the bacillus Mycobacterium tuberculosis (MT), isolated in 1882 by Robert Koch. Until the 1950s, X rays were used as a cheap method of diagnostic screening together with the tuberculin skin sensitivity test. In the diagnosis and treatment of TB, an important role was also played by surgery. The late Nineteenth century saw the introduction of the tuberculosis sanatorium, which proved to be one of the first useful measures against TB. Subsequently, Albert Calmette and Camille Guérin used a non-virulent MT strain to produce a live attenuated vaccine. In the 1980s and 1990s, the incidence of tuberculosis surged as a major opportunistic infection in people with HIV infection and AIDS; for this reason, a combined strategy based on improving drug treatment, diagnostic instruments and prevention was needed.
Collapse
Affiliation(s)
- M. MARTINI
- University of Genoa, Department of Health Sciences, Section of Medical History and Ethics, Genoa, Italy
- UNESCO CHAIR Anthropology of Health - Biosphere and Healing System, University of Genoa, Italy
| | - G. BESOZZI
- Centro di Formazione TB Italia Onlus
- Istituto Villa Marelli, Milano
| | - I. BARBERIS
- University of Genoa, Department of Health Sciences, Section of Medical History and Ethics, Genoa, Italy
- * Correspondence: Ilaria Barberis, University of Genoa, Department of Health Sciences, Section of Medical History and Ethics, largo R. Benzi 10 Pad 3, 16132 Genoa, Italy - Tel./Fax +39 010 353 85 02 - E-mail:
| |
Collapse
|
32
|
Naidoo K, Dookie N, Naidoo K, Yende-Zuma N, Chimukangara B, Bhushan A, Govender D, Gengiah S, Padayatchi N. Recurrent tuberculosis among HIV-coinfected patients: a case series from KwaZulu-Natal. Infect Drug Resist 2018; 11:1413-1421. [PMID: 30233220 PMCID: PMC6130302 DOI: 10.2147/idr.s150644] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Recurrent tuberculosis (TB) following TB treatment completion in HIV-infected individuals remains a major public health burden. We assessed the role of various risk factors in mediating the development of recurrent TB and subsequent resistance to antiretroviral therapy and anti-TB drugs. Patients and methods We analyzed secondary demographic, clinical, and laboratory data from medical records of five HIV-infected TB patients enrolled between 2009 and 2014 in a prospective observational study investigating TB recurrence. Paired clinical isolates of Myco-bacterium tuberculosis were typed by IS6110 restriction fragment length polymorphism analysis to determine the mechanism of TB recurrence. Plasma samples were genotyped to determine acquisition of HIV drug resistance mutations on antiretroviral treatment (ART). Results All five patients were HIV-coinfected, with a previous history of TB infection and prior exposure to anti-TB treatment, and residual lung damage, and demonstrated poor treatment adherence – significant risk factors linked to the development of recurrent TB disease. Furthermore, three of the five patients had multiple episodes of drug-susceptible TB infection with subsequent drug-resistant TB infection. Genotyping of the initial and recurrent M. tuberculosis isolates demonstrated three cases of recurrent TB because of relapse and two because of reinfection. All five patients had no mutations at ART initiation; however, by the end of the study follow-up, all patients developed dual class resistance. Conclusion This series demonstrates the complexity of recurrent TB in HIV coinfection. We highlight the challenges of managing coinfected patients and the increased propensity for the development of drug resistance. We report on the role of various risk factors mediating the development of resistance and subsequent clinical impact. This report underscores the need for structural clinical and adherence interventions for the management of complex treatment and dosing.
Collapse
Affiliation(s)
- Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa, .,South African Medical Research Council (SAMRC) - CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa,
| | - Navisha Dookie
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa, .,KwaZulu Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa
| | - Kasavan Naidoo
- South African Medical Research Council (SAMRC) - CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa,
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa,
| | - Benjamin Chimukangara
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa, .,KwaZulu Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa.,Department of Virology, National Health Laboratory Service, University of KwaZulu-Natal, Durban, South Africa
| | - Ambika Bhushan
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa,
| | - Dhineshree Govender
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa,
| | - Santhanalakshmi Gengiah
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa,
| | - Nesri Padayatchi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa, .,South African Medical Research Council (SAMRC) - CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa,
| |
Collapse
|
33
|
Abstract
Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) remain a common end-organ manifestation of viral infection. Subclinical and mild symptoms lead to neurocognitive and behavioral abnormalities. These are associated, in part, with viral penetrance and persistence in the central nervous system. Infections of peripheral blood monocytes, macrophages, and microglia are the primary drivers of neuroinflammation and neuronal impairments. While current antiretroviral therapy (ART) has reduced the incidence of HIV-associated dementia, milder forms of HAND continue. Depression, comorbid conditions such as infectious liver disease, drugs of abuse, antiretroviral drugs themselves, age-related neurodegenerative diseases, gastrointestinal maladies, and concurrent social and economic issues can make accurate diagnosis of HAND challenging. Increased life expectancy as a result of ART clearly creates this variety of comorbid conditions that often blur the link between the virus and disease. With the discovery of novel biomarkers, neuropsychologic testing, and imaging techniques to better diagnose HAND, the emergence of brain-penetrant ART, adjunctive therapies, longer life expectancy, and better understanding of disease pathogenesis, disease elimination is perhaps a realistic possibility. This review focuses on HIV-associated disease pathobiology with an eye towards changing trends in the face of widespread availability of ART.
Collapse
|
34
|
Pratt GW, Fan A, Melakeberhan B, Klapperich CM. A competitive lateral flow assay for the detection of tenofovir. Anal Chim Acta 2018; 1017:34-40. [PMID: 29534793 PMCID: PMC5877480 DOI: 10.1016/j.aca.2018.02.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/05/2018] [Accepted: 02/14/2018] [Indexed: 12/11/2022]
Abstract
Proper management of an HIV infection requires that a patient be at least 80-95% adherent to a prescribed drug regimen to avoid poor health outcomes and the development of drug-resistant HIV strains. Clinicians generally monitor adherence habits indirectly through patient self-reporting, pill counting, and electronic drug monitoring. While direct measurement of patient samples like urine for monitoring drug levels is possible, it requires specialized equipment and training that is not readily available in resource-limited settings where the need is greatest. In this work we report the development of an antibody that binds to tenofovir (TFV), a key small molecule drug for both the treatment and prevention of HIV, and a competitive lateral flow assay that uses that antibody to monitor urine samples for the presence of the drug. TFV was conjugated to an immunogenic protein and injected into rabbits to raise polyclonal antibodies sensitive to the drug. The antibodies were verified for TFV-sensitivity by immunoprecipitation and HPLC. A gold nanoparticle-based competitive assay was developed to detect the presence of TFV in urine samples with a sensitivity of 1 μg mL-1. This TFV assay could be deployed as a point-of-care device for adherence monitoring in resource-limited settings as a low-cost, accurate, and speedy alternative to current methods to better inform changes in treatment.
Collapse
Affiliation(s)
- George W Pratt
- College of Engineering, Boston University, Boston, MA 02215, United States
| | - Andy Fan
- College of Engineering, Boston University, Boston, MA 02215, United States
| | | | | |
Collapse
|
35
|
Mann D, Sant'Anna FM, Schmaltz CAS, Freitas DFS, Rolla VC, Cavalcante SC, Gutierrez-Galhardo MC. Cutaneous tuberculosis and HIV infection at a referral centre in Rio de Janeiro, Brazil. Mem Inst Oswaldo Cruz 2018; 113:e180184. [PMID: 30066752 PMCID: PMC6057310 DOI: 10.1590/0074-02760180184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/04/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cutaneous tuberculosis (CTB) is a rare extrapulmonary form of tuberculosis (TB). Despite the increase in the number of cases of TB and HIV, few cases of CTB have been reported. OBJECTIVE To describe CTB cases among patients with HIV infection from a cohort with tuberculosis. METHODS We describe a series of 15 CTB and HIV cases, based on secondary data from 2000 to 2016. Diagnosis was based on isolation of Mycobacterium tuberculosis in culture or clinical response to anti-tuberculous treatment associated with positive smear or histopathologic findings from affected skin or an adjacent lymph node. FINDINGS Scrofuloderma was present in 12 (80%) patients and solitary gumma in three (20%) patients. One case of scrofuloderma was associated with papulonecrotic tuberculid. Seven (46.6%) patients had pulmonary TB. Diagnosis was based on culture in nine patients (60%). The median CD4 cell count was 262 cells/µL. All patients were cured at the end of treatment (median time 6 months). Three patients presented with immune reconstitution inflammatory syndrome. CONCLUSIONS In this study, CTB associated with HIV infection presented as localised forms or in association with pulmonary TB. In patients with HIV who have subacute and chronic skin lesions, CTB should be considered in differential diagnosis, which may represent a good opportunity for early diagnosis of active TB.
Collapse
Affiliation(s)
- Danielle Mann
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil
| | - Flávia Marinho Sant'Anna
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Micobacterioses, Rio de Janeiro, RJ, Brasil
| | - Carolina Arana Stanis Schmaltz
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Micobacterioses, Rio de Janeiro, RJ, Brasil
| | - Dayvison Francis Saraiva Freitas
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil
| | - Valeria Cavalcanti Rolla
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Micobacterioses, Rio de Janeiro, RJ, Brasil
| | - Solange Cesar Cavalcante
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Micobacterioses, Rio de Janeiro, RJ, Brasil
| | - Maria Clara Gutierrez-Galhardo
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
36
|
Extraction and Serological Properties of Mycobacterium Cell Surface and Excreted Proteins. BIONANOSCIENCE 2018. [DOI: 10.1007/s12668-017-0492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
|
37
|
Sillman B, Bade AN, Dash PK, Bhargavan B, Kocher T, Mathews S, Su H, Kanmogne GD, Poluektova LY, Gorantla S, McMillan J, Gautam N, Alnouti Y, Edagwa B, Gendelman HE. Creation of a long-acting nanoformulated dolutegravir. Nat Commun 2018; 9:443. [PMID: 29402886 PMCID: PMC5799307 DOI: 10.1038/s41467-018-02885-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 01/04/2018] [Indexed: 12/22/2022] Open
Abstract
Potent antiretroviral activities and a barrier to viral resistance characterize the human immunodeficiency virus type one (HIV-1) integrase strand transfer inhibitor dolutegravir (DTG). Herein, a long-acting parenteral DTG was created through chemical modification to improve treatment outcomes. A hydrophobic and lipophilic modified DTG prodrug is encapsulated into poloxamer nanoformulations (NMDTG) and characterized by size, shape, polydispersity, and stability. Retained intracytoplasmic NMDTG particles release drug from macrophages and attenuate viral replication and spread of virus to CD4+ T cells. Pharmacokinetic tests in Balb/cJ mice show blood DTG levels at, or above, its inhibitory concentration90 of 64 ng/mL for 56 days, and tissue DTG levels for 28 days. NMDTG protects humanized mice from parenteral challenge of the HIV-1ADA strain for two weeks. These results are a first step towards producing a long-acting DTG for human use by affecting drug apparent half-life, cell and tissue drug penetration, and antiretroviral potency.
Collapse
Affiliation(s)
- Brady Sillman
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Aditya N Bade
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Prasanta K Dash
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Biju Bhargavan
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Ted Kocher
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Saumi Mathews
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Hang Su
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Georgette D Kanmogne
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Larisa Y Poluektova
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Santhi Gorantla
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - JoEllyn McMillan
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Nagsen Gautam
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Yazen Alnouti
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Benson Edagwa
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Howard E Gendelman
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| |
Collapse
|
38
|
Clinical study of tuberculosis in the head and neck region-11 years' experience and a review of the literature. Emerg Microbes Infect 2018; 7:4. [PMID: 29323108 PMCID: PMC5837174 DOI: 10.1038/s41426-017-0008-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/07/2017] [Indexed: 12/27/2022]
Abstract
Tuberculosis (TB) is an infectious disease and major health concern. Head and neck tuberculosis (HNTB) is relatively rare, but can arise in many regions, including the lymph nodes, larynx, oral cavity and pharynx. We retrospectively reviewed the clinical records of 60 patients diagnosed with HNTB in our department between March 2005 and January 2016. A review and summary of previous HNTB articles published in PubMed since 1885 was also performed. The subjects consisted of 17 males and 43 females, and the average age of patients was 45 ± 14.67 years. The major clinical presentation was a lump or swelling, followed by an oral ulcer and skin fistula. The most common site of tuberculosis was in the cervical lymph node. Three patients also suffered from a malignant tumor in the head and neck region. A total of 980 papers involving 5881 patients were included in our literature review. The included subjects ranged in age from 15 months to 100 years with a male-to-female ratio of 1.5:1. The larynx (38.92%), cervical lymph nodes (38.28%) and oral cavity (9.92%) were the three most common development sites. 465 patients were positive according to a HIV test, and 40 patients had comorbidities with different types of tumors. Head and neck tuberculosis should always be considered during a differential diagnosis for lesions in the head and neck region. Early diagnosis and treatment can greatly enhance the therapeutic effect and patients’ quality of life.
Collapse
|
39
|
Pharmacokinetics of a Long-Acting Nanoformulated Dolutegravir Prodrug in Rhesus Macaques. Antimicrob Agents Chemother 2017; 62:AAC.01316-17. [PMID: 29061742 PMCID: PMC5740312 DOI: 10.1128/aac.01316-17] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/28/2017] [Indexed: 01/24/2023] Open
Abstract
A nanoformulated myristoylated dolutegravir prodrug (NMDTG) was prepared using good laboratory practice protocols. Intramuscular injection of NMDTG (118 ± 8 mg/ml, 25.5 mg of DTG equivalents/kg of body weight) to three rhesus macaques led to plasma DTG levels of 86 ± 12 and 28 ± 1 ng/ml on days 35 and 91, respectively. The NMDTG platform showed no significant adverse events. Further modification may further extend the drug's apparent half-life for human use.
Collapse
|
40
|
Igarashi M, Ishizaki Y, Takahashi Y. New antituberculous drugs derived from natural products: current perspectives and issues in antituberculous drug development. J Antibiot (Tokyo) 2017; 71:ja2017126. [PMID: 29089593 DOI: 10.1038/ja.2017.126] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/05/2017] [Accepted: 09/13/2017] [Indexed: 12/13/2022]
Abstract
Tuberculosis is one of the most common and challenging infectious diseases worldwide. Especially, the lack of effective chemotherapeutic drugs for tuberculosis/human immunodeficiency virus co-infection and prevalence of multidrug-resistant and extensively drug-resistant tuberculosis remain to be serious clinical problems. Development of new drugs is a potential solution to fight tuberculosis. In this decade, the development status of new antituberculous drugs has been greatly advanced by the leading role of international organizations such as the Global Alliance for Tuberculosis Drug Development, Stop Tuberculosis Partnership and Global Health Innovative Technology Fund. In this review, we introduce the development status of new drugs for tuberculosis, focusing on those derived from natural products.The Journal of Antibiotics advance online publication, 1 November 2017; doi:10.1038/ja.2017.126.
Collapse
|
41
|
Méndez-Samperio P. Diagnosis of Tuberculosis in HIV Co-infected Individuals: Current Status, Challenges and Opportunities for the Future. Scand J Immunol 2017; 86:76-82. [PMID: 28513865 DOI: 10.1111/sji.12567] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/07/2017] [Indexed: 02/03/2023]
Abstract
Tuberculosis (TB) remains one of the most important causes of death among people co-infected with human immunodeficiency virus (HIV). The diagnosis of TB remains challenging in HIV co-infected individuals, due to a high frequency of smear-negative disease and high rates of extrapulmonary TB. Accurate, ease of use and rapid diagnosis of active TB are critical to the World Health Organization (WHO) End TB Strategy by 2050. Traditional laboratory techniques do not provide rapid and accurate results to effectively manage HIV co-infected patients. Over the last decade, molecular methods have provided significant steps in the fight against TB. However, many HIV co-infected patients do not have access to these molecular diagnostic tests. Given the costs closely related with confirming a TB diagnosis in HIV patients, an overtreatment for TB is used in this patient population. Nowadays, an estimated US $8 billion a year is required to provide TB treatment, which is very high compared with making an important strategy to improve the current diagnostic tests. This review focuses on current advances in diagnosing active TB with an emphasis on the diagnosis of HIV-associated TB. Also discussed are the main challenges that need to be overcome for improving an adequate initial diagnosis of active TB in HIV-positive patients.
Collapse
Affiliation(s)
- P Méndez-Samperio
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, IPN, México, México
| |
Collapse
|