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Windels EM, Wampande EM, Joloba ML, Boom WH, Goig GA, Cox H, Hella J, Borrell S, Gagneux S, Brites D, Stadler T. HIV co-infection is associated with reduced Mycobacterium tuberculosis transmissibility in sub-Saharan Africa. PLoS Pathog 2024; 20:e1011675. [PMID: 38696531 DOI: 10.1371/journal.ppat.1011675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 05/14/2024] [Accepted: 04/10/2024] [Indexed: 05/04/2024] Open
Abstract
Persons living with HIV are known to be at increased risk of developing tuberculosis (TB) disease upon infection with Mycobacterium tuberculosis (Mtb). However, it has remained unclear how HIV co-infection affects subsequent Mtb transmission from these patients. Here, we customized a Bayesian phylodynamic framework to estimate the effects of HIV co-infection on the Mtb transmission dynamics from sequence data. We applied our model to four Mtb genomic datasets collected in sub-Saharan African countries with a generalized HIV epidemic. Our results confirm that HIV co-infection is a strong risk factor for developing active TB. Additionally, we demonstrate that HIV co-infection is associated with a reduced effective reproductive number for TB. Stratifying the population by CD4+ T-cell count yielded similar results, suggesting that, in this context, CD4+ T-cell count is not a better predictor of Mtb transmissibility than HIV infection status alone. Together, our genome-based analyses complement observational household contact studies, and more firmly establish the negative association between HIV co-infection and Mtb transmissibility.
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Affiliation(s)
- Etthel M Windels
- Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | | | | | - W Henry Boom
- Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
| | - Galo A Goig
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Helen Cox
- University of Cape Town, Cape Town, South Africa
| | - Jerry Hella
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Sonia Borrell
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Daniela Brites
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Tanja Stadler
- Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
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Htet KKK, Chongsuvivatwong V, Aung ST. Sensitivity and specificity of tuberculosis signs and symptoms screening and adjunct role of social pathology characteristics in predicting bacteriologically confirmed tuberculosis in Myanmar. Trop Med Health 2021; 49:3. [PMID: 33407932 PMCID: PMC7789670 DOI: 10.1186/s41182-020-00292-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/21/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Globally, using tuberculosis signs and symptoms (TB-SS) as a screening tool has become less important due to its low sensitivity and specificity. We analyzed data from the Myanmar National Tuberculosis (TB) prevalence survey in 2010. The various TB screening models were developed to predict TB by using logistic regression analysis, and their performance on TB prediction was compared by the measures of overall performance, calibration and discrimination ability, and sensitivity and specificity to determine whether social pathology characteristics could be used as a TB screening tool. RESULTS Among 51,367 participants, 311 (0.6%) had bacteriologically confirmed TB, of which 37.2% were asymptomatic and 2% had a normal chest X-ray. Out of 32 various combinations of signs and symptoms, having any signs and symptoms gave the best sensitivity of 59.8% and specificity of 67.2%, but chest X-ray (CXR) alone gave the highest sensitivity (95.1%) and specificity (86.3%). The next best combination was cough only with a sensitivity of 24.4% and specificity of 85%. Other combinations had poor sensitivity (< 10%). Among various TB screening models, the overall performance R2 was higher in the combined models of social pathology and TB signs and symptoms as well as the social pathology model, compared to TB-SS models (> 10% versus < 3%), although all TB screening models were perfect to predict TB (Brier score = 0). The social pathology model shows a better calibration, more closer to 45° line of calibration plot with Hosmer-Lemeshow test p value = 0.787, than the combined models while it had a better discrimination ability in area under the curve, AUC = 80.4%, compared to TB-SS models with any signs and symptoms, AUC = 63.5% and with any cough, AUC = 57.1% (DeLong p value = 0.0001). Moreover, at the propensity score cutoff value ≥ 0.0053, the combined and social pathology models had sensitivity of ~ 80% and specificity of ~ 70%. The highest population attributable fraction to predict TB by social pathology characteristics was male gender (42.6%), age ≥ 55 years (31.0%), and underweight (30.4%). CONCLUSION Over one-third of bacteriologically confirmed TB was asymptomatic. The conventional TB-SS screening tool using any TB signs and symptoms had a lower sensitivity and specificity compared to CXR and social pathology screening tools. The social pathology characteristics as TB screening tool had good calibration and can improve the discrimination ability to predict TB than TB-SS screenings and should be encouraged.
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Affiliation(s)
- Kyaw Ko Ko Htet
- Department of Medical Research, Ministry of Health and Sports, Pyin Oo Lwin, Myanmar
| | | | - Si Thu Aung
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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The Association of Tuberculosis Mono-infection and Tuberculosis-Human Immunodeficiency Virus (TB-HIV) Co-infection in the Pathogenesis of Hypertensive Disorders of Pregnancy. Curr Hypertens Rep 2020; 22:104. [PMID: 33159613 DOI: 10.1007/s11906-020-01114-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW This review highlights the impact of TB mono-infection and TB-HIV co-infection on the pathogenesis of adverse maternal outcomes such as hypertensive disorders of pregnancy (HDP) and adverse fetal outcomes such as recurrent spontaneous abortion (RSA), fetal growth restriction (FGR), and low birth weight. RECENT FINDINGS Research has shown that HDP, such as severe pre-eclampsia (PE) and eclampsia, as well as adverse fetal outcomes such as recurrent spontaneous abortion, fetal growth restriction, and low birth weight, are higher in women diagnosed with TB mono-infection and even higher in TB-HIV co-infection compared to those without TB. This is speculated to occur due to exaggerated activation of both angiogenic factors such as vascular endothelial growth factor (VEGF), nitric oxide (NO), angiotensin 2, (Ang 2), intracellular adhesion molecules (ICAMs), and inflammatory cytokines such as interleukin 2 (IL-2), (IL-17), and interferon-gamma (INF-γ). There is a lack of information with regard to the pathogenesis of adverse maternal and fetal outcomes upon TB mono-infection and TB-HIV co-infection; therefore, further investigations on the impact of TB mono-infection and TB-HIV co-infection on adverse maternal and fetal outcomes are urgently needed. This will assist in improving diagnostic procedures in pregnant women affected with TB as wells as TB-HIV co-infection.
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Chepkondol GK, Jolly PE, Yatich N, Mbowe O, Jaoko WG. Types and prevalence of HIV-related opportunistic infections/conditions among HIV-positive patients attending Kenyatta National Hospital in Nairobi, Kenya. Afr Health Sci 2020; 20:615-624. [PMID: 33163022 PMCID: PMC7609085 DOI: 10.4314/ahs.v20i2.9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Although antiretroviral therapy (ART) has resulted in significant decrease in opportunistic infections (OIs), OIs continue to cause significant morbidity and mortality among HIV patients. Objective To determine the prevalence and types of HIV/AIDS-related OIs among patients attending Kenyatta National Hospital (KNH) in Nairobi, Kenya. Methods A cross-sectional study was conducted from May to August 2010 among patients ≥19 years. An interviewer-administered
questionnaire was used to collect data on socio-demographic factors, HIV and OIs. CD4 data were extracted
from clinical records. Results Most patients (72%) had lived with HIV for ≤ 5 years and 78.8% had an OI. The 3 most common OIs were TB (35%), Herpes Zoster (HZ; 15.4%) and oral thrush (OT; 8%). Years of HIV infection significantly predicted TB (p=0.01). Patients with CD4 ≤ 349 were almost twice as likely to have TB, than those with CD4 ≥500. Type of occupation predicted OT (p=0.04) with skilled workers less likely to have OT. Patients with primary/vocational/technical education were >3 times more likely to have HZ than those with tertiary education. Conclusion Due to the complex management of HIV and its associated OIs, appropriate implementation of the recommended guidelines for care and prevention among patients at KNH is important.
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Affiliation(s)
- Geoffrey K Chepkondol
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, 1665 University Blvd Birmingham, Alabama, United States
| | - Pauline E Jolly
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, 1665 University Blvd Birmingham, Alabama, United States
- Corresponding author: Pauline E Jolly, University of Alabama at Birmingham School of Public Health 1665 University Boulevard, RPHB 217 Birmingham, Alabama 35294-0022 Tel: 205-934-1823 Fax: 205-934-8665
| | - Nelly Yatich
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, 1665 University Blvd Birmingham, Alabama, United States
| | - Omar Mbowe
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, 1665 University Blvd Birmingham, Alabama, United States
| | - Walter G Jaoko
- Department of Medical Microbiology, University of Nairobi, P.O BOX 19676-00202, Nairobi, Kenya, Kenya AIDS Vaccine Initiative (KAVI), School of Medicine, University of Nairobi, P.O. BOX 196676-00202, Nairobi, Kenya
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Mycobacterium tuberculosis Reactivates HIV-1 via Exosome-Mediated Resetting of Cellular Redox Potential and Bioenergetics. mBio 2020; 11:mBio.03293-19. [PMID: 32127457 PMCID: PMC7064780 DOI: 10.1128/mbio.03293-19] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The synergy between Mycobacterium tuberculosis and human immunodeficiency virus-1 (HIV-1) interferes with therapy and facilitates the pathogenesis of both human pathogens. Fundamental mechanisms by which M. tuberculosis exacerbates HIV-1 infection are not clear. Here, we show that exosomes secreted by macrophages infected with M. tuberculosis, including drug-resistant clinical strains, reactivated HIV-1 by inducing oxidative stress. Mechanistically, M. tuberculosis-specific exosomes realigned mitochondrial and nonmitochondrial oxygen consumption rates (OCR) and modulated the expression of host genes mediating oxidative stress response, inflammation, and HIV-1 transactivation. Proteomics analyses revealed the enrichment of several host factors (e.g., HIF-1α, galectins, and Hsp90) known to promote HIV-1 reactivation in M. tuberculosis-specific exosomes. Treatment with a known antioxidant-N-acetyl cysteine (NAC)-or with inhibitors of host factors-galectins and Hsp90-attenuated HIV-1 reactivation by M. tuberculosis -specific exosomes. Our findings uncover new paradigms for understanding the redox and bioenergetics bases of HIV-M. tuberculosis coinfection, which will enable the design of effective therapeutic strategies.IMPORTANCE Globally, individuals coinfected with the AIDS virus (HIV-1) and with M. tuberculosis (causative agent of tuberculosis [TB]) pose major obstacles in the clinical management of both diseases. At the heart of this issue is the apparent synergy between the two human pathogens. On the one hand, mechanisms induced by HIV-1 for reactivation of TB in AIDS patients are well characterized. On the other hand, while clinical findings clearly identified TB as a risk factor for HIV-1 reactivation and associated mortality, basic mechanisms by which M. tuberculosis exacerbates HIV-1 replication and infection remain poorly characterized. The significance of our research is in identifying the role of fundamental mechanisms such as redox and energy metabolism in catalyzing HIV-M. tuberculosis synergy. The quantification of redox and respiratory parameters affected by M. tuberculosis in stimulating HIV-1 will greatly enhance our understanding of HIV-M. tuberculosis coinfection, leading to a wider impact on the biomedical research community and creating new translational opportunities.
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Marimani M, Ahmad A, Duse A. The role of epigenetics, bacterial and host factors in progression of Mycobacterium tuberculosis infection. Tuberculosis (Edinb) 2018; 113:200-214. [PMID: 30514504 DOI: 10.1016/j.tube.2018.10.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/21/2018] [Accepted: 10/23/2018] [Indexed: 12/29/2022]
Abstract
Tuberculosis (TB) infection caused by Mycobacterium tuberculosis (Mtb) is still a persistent global health problem, particularly in developing countries. The World Health Organization (WHO) reported a mortality rate of about 1.8 million worldwide due to TB complications in 2015. The Bacillus Calmette-Guérin (BCG) vaccine was introduced in 1921 and is still widely used to prevent TB development. This vaccine offers up to 80% protection against various forms of TB; however its efficacy against lung infection varies among different geographical settings. Devastatingly, the development of various forms of drug-resistant TB strains has significantly impaired the discovery of effective and safe anti-bacterial agents. Consequently, this necessitated discovery of new drug targets and novel anti-TB therapeutics to counter infection caused by various Mtb strains. Importantly, various factors that contribute to TB development have been identified and include bacterial resuscitation factors, host factors, environmental factors and genetics. Furthermore, Mtb-induced epigenetic changes also play a crucial role in evading the host immune response and leads to bacterial persistence and dissemination. Recently, the application of GeneXpert MTB/RIF® to rapidly diagnose and identify drug-resistant strains and discovery of different molecular markers that distinguish between latent and active TB infection has motivated and energised TB research. Therefore, this review article will briefly discuss the current TB state, highlight various mechanisms employed by Mtb to evade the host immune response as well as to discuss some modern molecular techniques that may potentially target and inhibit Mtb replication.
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Affiliation(s)
- Musa Marimani
- Clinical Microbiology and Infectious Diseases, School of Pathology, Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aijaz Ahmad
- Clinical Microbiology and Infectious Diseases, School of Pathology, Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Infection Control, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, South Africa.
| | - Adriano Duse
- Clinical Microbiology and Infectious Diseases, School of Pathology, Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Infection Control, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, South Africa
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Horo K, N’Guessan R, Koffi MO, Kouamé-N’Takpé N, Koné A, Samaké K, Koffi L, Ahui B, Brou-Gode C, N’Gom A, Kouassi B, Koffi N, Aka-Danguy E. Test Xpert ® MTB/RIF et dépistage des nouveaux cas de tuberculose pulmonaire en routine dans une zone de haute endémicité tuberculeuse. Rev Mal Respir 2017; 34:749-757. [DOI: 10.1016/j.rmr.2016.10.874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
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Krsulovic FAM, Lima M. Tuberculosis Epidemiology at the Country Scale: Self-Limiting Process and the HIV Effects. PLoS One 2016; 11:e0153710. [PMID: 27093296 PMCID: PMC4836699 DOI: 10.1371/journal.pone.0153710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 04/01/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The global spread of the human immunodeficiency virus (HIV) is the main hypothesis behind tuberculosis (TB) positive trends in the last decades, according to modeling studies and World Health Organization Reports (WHO). On one hand, TB (WHO) reports do not explicitly consider a modeling approach, but cover country and global TB trends. On the other hand, modeling studies usually do not cover the scale of WHO reports, because of the amount of parameters estimated to describe TB natural history. Here we combined these two principal sources of TB studies covering TB High Burden Countries (HBCs) dynamics. Our main goals were: (i) to detect the endogenous component of TB dynamics since 1974 for TB HBCs; and (ii) to explore the HIV exogenous effects on TB models`parameters. METHODS AND FINDINGS We explored the relationship between the TB per capita population rate of change (RI) and the infectious class size following an endogenous/exogenous framework. RI can be affected by intra-population processes (i.e. competition, predation) and exogenous variables like HIV. We found that TB dynamics had always a strong endogenous component, represented by a negative correlation between TB population size and RI, which was captured by the discrete logistic model. Moreover, we explored the HIV exogenous effects on TB models`parameters. We found that overall the TB+HIV logistic model was more parsimonious than TB model alone, principally in the African region. Our results showed that HIV affected principally TB carrying capacity, as expected by the known HIV effects on TB natural-history. We also tested if DOTS (Directly Observed Treatment Short-Course Strategy), poverty levels and BCG (Bacillus Calmette-Guérin) coverage explained the models´ residuals variances, but they did not. CONCLUSIONS Since 1974, TB dynamics were categorized in distinct chronological domains, with different dynamics but nearly the same underlying mechanism: a negative relationship between RI and infected class size (i.e. self-limiting). In the last decades, not only HIV spread represented a new TB chronological domain, but it also has been pushing TB carrying capacity (K) to higher levels. TB has a complex natural-history and imposes real challenges to model its dynamics. Yet, we were able to explore and reveal the main drivers of TB dynamics for HBCs since 1974, through a simple approach. Based on our results, we suggest that the endogenous view should be considered as a plausible hypothesis to model and explain TB dynamics and that future World Health Organization reports could include the endogenous/exogenous framework as a supplement to help to decipher the main drivers of TB dynamics and other diseases.
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Affiliation(s)
| | - Mauricio Lima
- Pontificia Universidad Católica de Chile, Santiago, Chile
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Ayele HT, van Mourik MSM, Bonten MJM. Effect of isoniazid preventive therapy on tuberculosis or death in persons with HIV: a retrospective cohort study. BMC Infect Dis 2015; 15:334. [PMID: 26269094 PMCID: PMC4535686 DOI: 10.1186/s12879-015-1089-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/04/2015] [Indexed: 11/13/2022] Open
Abstract
Background Isoniazid preventive therapy (IPT) is a recommended strategy for prevention of tuberculosis (TB) in persons with Human Immunodeficiency Virus (HIV) although the benefits have not been unequivocally demonstrated in routine clinical practice with widespread ART adoption. Therefore, we assessed the effectiveness of IPT in prevention of TB or death in patients treated with antiretroviral therapy (ART) in a chronic care setting. Methods Retrospective cohort study of HIV patients enrolled in chronic care from 2007 to 2013. Eligible participants were HIV infected subjects (age > 15 years) with no (history of) TB. The combined effect of IPT and ART on the composite outcome (TB or death) was estimated using time-dependent Cox regression with adjustment for baseline covariates. Results 1,922 patients were included, 374 (19.4 %) received IPT and 258 (13.4 %) developed TB or deceased. The median follow-up duration of the cohort was 839 days, with a total of 5491 person years. In unadjusted analysis, the combination of IPT and ART lowered the hazard of TB or death by 65 % [HR = 0.35; 95 % CI (0.16, 0.77)] compared to ART alone. Even after adjustment for confounders, the combined effect of ART and IPT resulted in a 60 % hazard reduction of TB or death in comparison to participants who received ART without IPT [HR = 0.40; 95 % CI (0.18, 0.87)]. The IPT-specific benefit in patients not receiving ART could not be reliably estimated due to high rates of ART adoption. Conclusion The combined effect of IPT and ART to prevent TB or death in HIV patients in a non-experimental setting in comparison to ART alone was estimated to be 60 %.
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Affiliation(s)
- Henok Tadesse Ayele
- Julius Center for Health Sciences and Primary Care, Infectious Diseases Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Public Health, Dilla University College of Medicine & Health Sciences and Referral Hospital, Dilla, Gedeo Zone, Ethiopia.
| | - Maaike S M van Mourik
- Department of Medical Microbiology and Infection Control, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, Infectious Diseases Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Medical Microbiology and Infection Control, University Medical Center Utrecht, Utrecht, The Netherlands.
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Abstract
Mycobacterial infections can cause a variety of different manifestations. The increasing incidence of these infections worldwide brought another medical dilemma: immunological manifestations characterized by the presence of many autoantibodies and concomitant presence of autoimmune diseases. The burden of tuberculosis reactivation that emerged with immunosuppressive therapy worsened with the growing use of biological disease-modifying antirheumatic drugs (DMARDs). This review will address the relationship between the immune system and mycobacteria.
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Affiliation(s)
- F Machado Ribeiro
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, RJ, Brazil
| | - T Goldenberg
- Department of Pneumology/ENSP-Fundação Oswaldo Cruz, RJ, Brazil
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Shanmuganathan R, Subramaniam ID. Clinical manifestation and risk factors of tuberculosis infection in Malaysia: case study of a community clinic. Glob J Health Sci 2015; 7:110-20. [PMID: 25946947 PMCID: PMC4802090 DOI: 10.5539/gjhs.v7n4p110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/01/2014] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The main aim of this study was to describe the clinical manifestation of tuberculosis infection cases in Malaysia and to determine the individual risk factors for their occurrence. METHODOLOGY The study adopted a quantitative research approach with use of descriptive statistical approach. The study setting was a community clinic which treats walk in patients who are mainly living and working in the surrounding areas. The study was conducted for a period of one year. All tuberculosis patients who sought treatment in the clinic during the time were included in this study. The total number of cases was 40. Data was collected from the medical records of the tuberculosis patients. The risk factors selected for investigation were demographic characteristics of age and sex, personal habits such as smoking, drug use and alcohol and presence of diseases such as human immunodeficiency virus positive (HIV+), diabetes mellitus, cancer, cyanotic heart disease, renal failure and steroid use. RESULTS Patients in the age group ranging from 41 to 50 years had the highest incidence of the infection. Smoking appears to be the most important risk factor for contracting followed by drug abuse, HIV+ infection and diabetes mellitus. CONCLUSIONS People with diseases such as diabetes mellitus and HIV that are high risk factors for TB should be screened for TB so that early detection and intervention is possible. Educational programs should be carried out to create awareness among the at risk groups.
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Long R, Niruban S, Heffernan C, Cooper R, Fisher D, Ahmed R, Egedahl ML, Fur R. A 10-year population based study of 'opt-out' HIV testing of tuberculosis patients in Alberta, Canada: national implications. PLoS One 2014; 9:e98993. [PMID: 24911262 PMCID: PMC4049754 DOI: 10.1371/journal.pone.0098993] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 05/09/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Compliance with the recommendation that all tuberculosis (TB) patients be tested for human immunodeficiency virus (HIV) has not yet been achieved in Canada or globally. METHODS The experience of "opt-out" HIV testing of TB patients in the Province of Alberta, Canada is described over a 10-year period, 2003-2012. Testing rates are reported before and after the introduction of the "opt-out" approach. Risk factors for HIV seropositivity are described and demographic, clinical and laboratory characteristics of TB patients who were newly diagnosed versus previously diagnosed with HIV are compared. Genotypic clusters, defined as groups of two or more cases whose isolates of Mycobacterium tuberculosis had identical DNA fingerprints over the 10-year period or within 2 years of one another, were analyzed for their ability to predict HIV co-infection. RESULTS HIV testing rates were 26% before and 90% after the introduction of "opt-out" testing. During the "opt-out" testing years those <15 or >64 years of age at diagnosis were less likely to have been tested. In those tested the prevalence of HIV was 5.6%. In the age group 15-64 years, risk factors for HIV were: age (35-64 years), Canadian-born Aboriginal or foreign-born sub-Saharan African origin, and combined respiratory and non-respiratory disease. Compared to TB patients previously known to be HIV positive, TB patients newly discovered to be HIV positive had more advanced HIV disease (lower CD4 counts; higher viral loads) at diagnosis. Large cluster size was associated with Aboriginal ancestry. Cluster size predicted HIV co-infection in Aboriginal peoples when clusters included all cases reported over 10 years but not when clusters included cases reported within 2 years of one another. CONCLUSION "Opt-out" HIV testing of TB patients is effective and well received. Universal HIV testing of TB patients (>80% of patients tested) has immediate (patients) and longer-term (TB/HIV program planning) benefits.
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Affiliation(s)
- Richard Long
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Selvanayagam Niruban
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Courtney Heffernan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ryan Cooper
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Dina Fisher
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rabia Ahmed
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mary Lou Egedahl
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rhonda Fur
- Alberta Health Services, Alberta, Canada
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OGBERA A, KAPUR A, ODEYEMI K, LONGE-PETERS K, ADEYEYE O, ODENIYI I, OGUNNOWO B. Screening for diabetes mellitus and human immunodefiency virus infection in persons with tuberculosis. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2014; 55:42-5. [PMID: 25916018 PMCID: PMC4718331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Nigeria is a country saddled with a high tuberculosis (TB) and human immunodeficiency virus (HIV) burden but the possible combination of these communicable diseases with diabetes mellitus (DM) has been overlooked. We undertook to determine the burden of HIV and DM in persons with TB by documenting the prevalence rates of these disorders. METHODS This is a cross-sectional Study that was conducted within 54TB/DOT centers in Lagos State. A total of 3,376 persons with TB who were on antiTB drugs were screened for HIV and DM using standardized tests. Statistical analysis was performed using Students t test and chi square. RESULTS The frequency of occurrence of DM in TB and that of HIV in TB were comparable (4.8% Vs 3.5%). The Study subjects with DM were older, had higher waist circumference measurements and had higher proportions of hypertension compared to the subjects without DM. The combination of HIV and DM in TB was found in (0.3%). We also noted that DM in TB and HIV in TB occurred more frequently in the third and fourth decades of life. CONCLUSION This study demonstrated the potential co existence of HIV, DM and Tuberculosis. It is therefore important that these two diseases are sought for in patients with TB considering the changing epidemiology of these diseases particularly in developing countries like Nigeria.
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Affiliation(s)
- A.O. OGBERA
- Department of Medicine, Lagos State University Teaching Hospital Ikeja, Lagos Nigeria;,Correspondence: Anthonia Ogbera, Department of Medicine, Lagos State University Teaching Hospital Ikeja, Lagos Nigeria - .
| | - A. KAPUR
- World Diabetes Foundation Gentofte Denmark
| | - K. ODEYEMI
- Department of Community Medicine, Lagos State University Teaching Hospital Idi-araba, Lagos Nigeria
| | - K. LONGE-PETERS
- Department of Community Medicine, Lagos State University Teaching Hospital Idi-araba, Lagos Nigeria
| | - O.O. ADEYEYE
- Department of Medicine, Lagos State University Teaching Hospital Ikeja, Lagos Nigeria
| | - I. ODENIYI
- Department of Medicine, Lagos University Teaching Hospital, Idi-araba Lagos Nigeria
| | - B.E. OGUNNOWO
- Department of Community Medicine, Lagos State University Teaching Hospital Idi-araba, Lagos Nigeria
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Deffur A, Mulder NJ, Wilkinson RJ. Co-infection with Mycobacterium tuberculosis and human immunodeficiency virus: an overview and motivation for systems approaches. Pathog Dis 2013; 69:101-13. [PMID: 23821533 DOI: 10.1111/2049-632x.12060] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 06/17/2013] [Accepted: 06/20/2013] [Indexed: 12/13/2022] Open
Abstract
Tuberculosis is a devastating disease that accounts for a high proportion of infectious disease morbidity and mortality worldwide. HIV-1 co-infection exacerbates tuberculosis. Enhanced understanding of the host-pathogen relationship in HIV-1 and Mycobacterium tuberculosis co-infection is required. While reductionist approaches have yielded many valuable insights into disease pathogenesis, systems approaches are required that develop data-driven models able to predict emergent properties of this complex co-infection system in order to develop novel therapeutic approaches and to improve diagnostics. Here, we provide a pathogenesis-focused overview of HIV-TB co-infection followed by an introduction to systems approaches and concrete examples of how such approaches are useful.
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Affiliation(s)
- Armin Deffur
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
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15
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Clark IT, Lobato MN, Gutierrez J, Sosa LE. HIV status among patients with tuberculosis and HIV testing practices by Connecticut health care providers. J Int Assoc Provid AIDS Care 2013; 12:261-5. [PMID: 23442493 DOI: 10.1177/2325957412473649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Knowing the human immunodeficiency virus (HIV) status of persons infected with Mycobacterium tuberculosis is important for individual treatment and preventing transmission. This evaluation analyzed surveillance data and surveyed health care providers who care for patients with HIV and tuberculosis (TB) to understand the factors contributing to suboptimal levels of Connecticut patients with TB having a known HIV status. During 2008 to 2010, 208 (76.2%) of 273 patients had a known HIV status; 12 (5.8%) were HIV-positive. Patients who were more likely to have a known HIV status were younger (40.5 vs 54.6 years, P < .001) or received care in a TB clinic (risk ratio, 1.26; 95% confidence interval, 1.12-1.42). Among 77 providers, 48 (62.3%) completed the survey, 42 (87.5%) reported routinely offering HIV testing to patients with TB, and 26 (54.2%) reported routinely offering HIV testing to patients with latent TB infection (LTBI). We conclude that interventions for improving HIV testing should focus on non-TB clinic providers and patients with LTBI.
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Affiliation(s)
- Ian T Clark
- Lifespan Learning Institute, Lifespan Health System, Providence, RI, USA.
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16
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Narasimhan P, Wood J, MacIntyre CR, Mathai D. Risk factors for tuberculosis. Pulm Med 2013; 2013:828939. [PMID: 23476764 PMCID: PMC3583136 DOI: 10.1155/2013/828939] [Citation(s) in RCA: 311] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 12/27/2012] [Accepted: 01/05/2013] [Indexed: 01/07/2023] Open
Abstract
The risk of progression from exposure to the tuberculosis bacilli to the development of active disease is a two-stage process governed by both exogenous and endogenous risk factors. Exogenous factors play a key role in accentuating the progression from exposure to infection among which the bacillary load in the sputum and the proximity of an individual to an infectious TB case are key factors. Similarly endogenous factors lead in progression from infection to active TB disease. Along with well-established risk factors (such as human immunodeficiency virus (HIV), malnutrition, and young age), emerging variables such as diabetes, indoor air pollution, alcohol, use of immunosuppressive drugs, and tobacco smoke play a significant role at both the individual and population level. Socioeconomic and behavioral factors are also shown to increase the susceptibility to infection. Specific groups such as health care workers and indigenous population are also at an increased risk of TB infection and disease. This paper summarizes these factors along with health system issues such as the effects of delay in diagnosis of TB in the transmission of the bacilli.
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Affiliation(s)
- Padmanesan Narasimhan
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia
| | - James Wood
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia
| | - Chandini Raina MacIntyre
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia
| | - Dilip Mathai
- Infectious Diseases Research and Training Centre, Department of Medicine-I and Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
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17
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Buu TN, van Soolingen D, Huyen MNT, Lan NTN, Quy HT, Tiemersma EW, Kremer K, Borgdorff MW, Cobelens FGJ. Increased transmission of Mycobacterium tuberculosis Beijing genotype strains associated with resistance to streptomycin: a population-based study. PLoS One 2012; 7:e42323. [PMID: 22912700 PMCID: PMC3418256 DOI: 10.1371/journal.pone.0042323] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 07/06/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies have shown that the Mycobacterium tuberculosis Beijing genotype is an emerging pathogen that is frequently associated with drug resistance. This suggests that drug resistant Beijing strains have a relatively high transmission fitness compared to other drug-resistant strains. METHODS AND FINDINGS We studied the relative transmission fitness of the Beijing genotype in relation to anti-tuberculosis drug resistance in a population-based study of smear-positive tuberculosis patients prospectively recruited and studied over a 4-year period in rural Vietnam. Transmission fitness was analyzed by clustering of cases on basis of three DNA typing methods. Of 2531 included patients, 2207 (87%) were eligible for analysis of whom 936 (42%) were in a DNA fingerprint cluster. The clustering rate varied by genotype with 292/786 (37%) for the Beijing genotype, 527/802 (67%) for the East-African Indian (EAI) genotype, and 117/619 (19%) for other genotypes. Clustering was associated with the EAI compared to the Beijing genotype (adjusted odds ratio (OR(adj)) 3.4: 95% CI 2.8-4.4). Patients infected with streptomycin-resistant strains were less frequently clustered than patients infected with streptomycin-susceptible strains when these were of the EAI genotype (OR(adj) 0.6, 95% CI 0.4-0.9), while this pattern was reversed for strains of the Beijing genotype (OR(adj) 1.3, 95% CI 1.0-1.8, p for difference 0.002). The strong association between Beijing and MDR-TB (OR(adj) 7.2; 95% CI 4.2-12.3) existed only if streptomycin resistance was present. CONCLUSIONS Beijing genotype strains showed less overall transmissibility than EAI strains, but when comparisons were made within genotypes, Beijing strains showed increased transmission fitness when streptomycin-resistant, while the reverse was observed for EAI strains. The association between MDR-TB and Beijing genotype in this population was strongly dependent on resistance to streptomycin. Streptomycin resistance may provide Beijing strains with a fitness advantage over other genotypes and predispose to multidrug resistance in patients infected with Beijing strains.
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Affiliation(s)
- Tran N. Buu
- Tuberculosis Control Department, Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Dick van Soolingen
- Laboratory for Infectious Diseases and Screening, National Institute of Public Health and The Environment, Bilthoven, The Netherlands
- Department of Medical Microbiology, University Medical Center Saint Radboud, Nijmegen, The Netherlands
| | - Mai N. T. Huyen
- Microbiology Department, Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen T. N. Lan
- Microbiology Department, Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Hoang T. Quy
- Medical Department, Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Edine W. Tiemersma
- Asia Department, KNCV Tuberculosis Foundation, The Hague, The Netherlands
- Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands
| | - Kristin Kremer
- Division of Communicable Diseases, Health Security & Environment,World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Martien W. Borgdorff
- Infectious Diseases Cluster, Amsterdam Municipal Health Service, Amsterdam, The Netherlands
| | - Frank G. J. Cobelens
- Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands
- Department of Global Health, Academic Medical Center, Amsterdam, The Netherlands
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18
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Abstract
A syndemic is defined as the convergence of two or more diseases that act synergistically to magnify the burden of disease. The intersection and syndemic interaction between the human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics have had deadly consequences around the world. Without adequate control of the TB-HIV syndemic, the long-term TB elimination target set for 2050 will not be reached. There is an urgent need for additional resources and novel approaches for the diagnosis, treatment, and prevention of both HIV and TB. Moreover, multidisciplinary approaches that consider HIV and TB together, rather than as separate problems and diseases, will be necessary to prevent further worsening of the HIV-TB syndemic. This review examines current knowledge of the state and impact of the HIV-TB syndemic and reviews the epidemiological, clinical, cellular, and molecular interactions between HIV and TB.
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19
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Monitoring linked epidemics: the case of tuberculosis and HIV. PLoS One 2010; 5:e8796. [PMID: 20098716 PMCID: PMC2808389 DOI: 10.1371/journal.pone.0008796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 12/28/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The tight epidemiological coupling between HIV and its associated opportunistic infections leads to challenges and opportunities for disease surveillance. METHODOLOGY/PRINCIPAL FINDINGS We review efforts of WHO and collaborating agencies to track and fight the TB/HIV co-epidemic, and discuss modeling--via mathematical, statistical, and computational approaches--as a means to identify disease indicators designed to integrate data from linked diseases in order to characterize how co-epidemics change in time and space. We present R(TB/HIV), an index comparing changes in TB incidence relative to HIV prevalence, and use it to identify those sub-Saharan African countries with outlier TB/HIV dynamics. R(TB/HIV) can also be used to predict epidemiological trends, investigate the coherency of reported trends, and cross-check the anticipated impact of public health interventions. Identifying the cause(s) responsible for anomalous R(TB/HIV) values can reveal information crucial to the management of public health. CONCLUSIONS/SIGNIFICANCE We frame our suggestions for integrating and analyzing co-epidemic data within the context of global disease monitoring. Used routinely, joint disease indicators such as R(TB/HIV) could greatly enhance the monitoring and evaluation of public health programs.
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21
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DeRiemer K, de Jong BC. Catch Them While You Can! Am J Respir Crit Care Med 2008; 178:5-6. [DOI: 10.1164/rccm.200804-589ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Bouke C. de Jong
- New York University
New York, New York
and
MRC Laboratories
Banjul, The Gambia
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22
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Kik SV, Verver S, van Soolingen D, de Haas PEW, Cobelens FG, Kremer K, van Deutekom H, Borgdorff MW. Tuberculosis Outbreaks Predicted by Characteristics of First Patients in a DNA Fingerprint Cluster. Am J Respir Crit Care Med 2008; 178:96-104. [DOI: 10.1164/rccm.200708-1256oc] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Affiliation(s)
- Wing Wai Yew
- Tuberculosis and Chest Unit, Grantham Hospital, Hong Kong, China.
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