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Machowski EE, Letutu M, Lebina L, Waja Z, Msandiwa R, Milovanovic M, Gordhan BG, Otwombe K, Friedrich SO, Chaisson R, Diacon AH, Kana B, Martinson N. Comparing rates of mycobacterial clearance in sputum smear-negative and smear-positive adults living with HIV. BMC Infect Dis 2021; 21:466. [PMID: 34022850 PMCID: PMC8141145 DOI: 10.1186/s12879-021-06133-4] [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: 09/18/2020] [Accepted: 05/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Pulmonary tuberculosis (TB) in people living with HIV (PLH) frequently presents as sputum smear-negative. However, clinical trials of TB in adults often use smear-positive individuals to ensure measurable bacterial responses following initiation of treatment, thereby excluding HIV-infected patients from trials. Methods In this prospective case cohort study, 118 HIV-seropositive TB patients were assessed prior to initiation of standard four-drug TB therapy and at several time points through 35 days. Sputum bacillary load, as a marker of treatment response, was determined serially by: smear microscopy, Xpert MTB/RIF, liquid culture, and colony counts on agar medium. Results By all four measures, patients who were baseline smear-positive had higher bacterial loads than those presenting as smear-negative, until day 35. However, most smear-negative PLH had significant bacillary load at enrolment and their mycobacteria were cleared more rapidly than smear-positive patients. Smear-negative patients’ decline in bacillary load, determined by colony counts, was linear to day 7 suggesting measurable bactericidal activity. Moreover, the decrease in bacterial counts was comparable to smear-positive individuals. Increasing cycle threshold values (Ct) on the Xpert assay in smear-positive patients to day 14 implied decreasing bacterial load. Conclusion Our data suggest that smear-negative PLH can be included in clinical trials of novel treatment regimens as they contain sufficient viable bacteria, but allowances for late exclusions would have to be made in sample size estimations. We also show that increases in Ct in smear-positive patients to day 14 reflect treatment responses and the Xpert MTB/RIF assay could be used as biomarker for early treatment response. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06133-4.
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Affiliation(s)
- Edith E Machowski
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research (CBTBR), University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa.
| | - Matebogo Letutu
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Limakatso Lebina
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Waja
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Reginah Msandiwa
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bhavna G Gordhan
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research (CBTBR), University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sven O Friedrich
- TASK Applied Science, Bellville, Cape Town, South Africa and Pulmonology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - Andreas H Diacon
- TASK Applied Science, Bellville, Cape Town, South Africa and Pulmonology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Bavesh Kana
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research (CBTBR), University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa
| | - Neil Martinson
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research (CBTBR), University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa.,Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Tiberi S, Carvalho ACC, Sulis G, Vaghela D, Rendon A, Mello FCDQ, Rahman A, Matin N, Zumla A, Pontali E. The cursed duet today: Tuberculosis and HIV-coinfection. Presse Med 2017; 46:e23-e39. [PMID: 28256380 DOI: 10.1016/j.lpm.2017.01.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/23/2016] [Accepted: 01/17/2017] [Indexed: 01/22/2023] Open
Abstract
The tuberculosis (TB) and HIV syndemic continues to rage and are a major public health concern worldwide. This deadly association raises complexity and represent a significant barrier towards TB elimination. TB continues to be the leading cause of death amongst HIV-infected people. This paper reports the challenges that lay ahead and outlines some of the current and future strategies that may be able to address this co-epidemic efficiently. Improved diagnostics, cheaper and more effective drugs, shorter treatment regimens for both drug-sensitive and drug-resistant TB are discussed. Also, special topics on drug interactions, TB-IRIS and TB relapse are also described. Notwithstanding the defeats and meagre investments, diagnosis and management of the two diseases have seen significant and unexpected improvements of late. On the HIV side, expansion of ART coverage, development of new updated guidelines aimed at the universal treatment of those infected, and the increasing availability of newer, more efficacious and less toxic drugs are an essential element to controlling the two epidemics. On the TB side, diagnosis of MDR-TB is becoming easier and faster thanks to the new PCR-based technologies, new anti-TB drugs active against both sensitive and resistant strains (i.e. bedaquiline and delamanid) have been developed and a few more are in the pipeline, new regimens (cheaper, shorter and/or more effective) have been introduced (such as the "Bangladesh regimen") or are being tested for MDR-TB and drug-sensitive-TB. However, still more resources will be required to implement an integrated approach, install new diagnostic tests, and develop simpler and shorter treatment regimens.
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Affiliation(s)
- Simon Tiberi
- Barts health NHS trust, Royal London hospital, division of infection, 80, Newark street, E1 2ES London, United Kingdom.
| | - Anna Cristina C Carvalho
- Oswaldo Cruz institute (IOC), laboratory of innovations in therapies, education and bioproducts, (LITEB), Fiocruz, Rio de Janeiro, Brazil.
| | - Giorgia Sulis
- University of Brescia, university department of infectious and tropical diseases, World health organization collaborating centre for TB/HIV co-infection and TB elimination, Brescia, Italy.
| | - Devan Vaghela
- Barts Health NHS Trust, Royal London hospital, department of respiratory medicine, 80, Newark street, E1 2ES London, United Kingdom.
| | - Adrian Rendon
- Hospital universitario de Monterrey, centro de investigación, prevención y tratamiento de infecciones respiratorias, Monterrey, Nuevo León UANL, Mexico.
| | - Fernanda C de Q Mello
- Federal university of Rio de Janeiro, instituto de Doenças do Tórax (IDT)/Clementino Fraga Filho hospital (CFFH), rua Professor Rodolpho Paulo Rocco, n° 255 - 1° Andar - Cidade Universitária - Ilha do Fundão, 21941-913, Rio De Janeiro, Brazil.
| | - Ananna Rahman
- Papworth hospital NHS foundation trust, department of respiratory medicine, Papworth Everard, Cambridge, United Kingdom.
| | - Nashaba Matin
- Barts Health NHS Trust, Royal London hospital, HIV medicine, infection and immunity, London, United Kingdom.
| | - Ali Zumla
- UCL hospitals NHS Foundation Trust, university college London, NIHR biomedical research centre, division of infection and immunity, London, United Kingdom.
| | - Emanuele Pontali
- Galliera hospital, department of infectious diseases, Genoa, Italy.
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