Background Most studies assessing drug resistant tuberculosis (DRTB) in human immunodeficiency virus (HIV) co-infected patients in India have used conventional culture- based systems to diagnose DRTB that have a longer turnaround time leading to risk of amplification of resistance to an empirical regimen. We determined the prevalence of DRTB amongst people living with HIV (PLHIV) using the line probe assay and determined risk factors associated with the presence of multi drug resistant tuberculosis (MDRTB). Methods A Cross-sectional study was undertaken at Poona Hospital and Research Center (PHRC) and the Institute of Infectious Diseases, two tertiary level private care centers in Pune, India. Consenting PLHIV with confirmed Pulmonary TB (PTB) and/or extra-pulmonary TB (EPTB) diagnosed based on detection of Mycobacterium TB by line probe assay (Geno Type MTBDRplus version 2) on clinical specimens were included. Those with documented past history of DRTB were excluded. Resistance against anti-TB drugs was determined by the same assay. The prevalence of any form of drug resistant TB (DRTB), MDRTB, Rifampicin resistant TB (RRTB) and Isoniazid (INH) mono-resistant TB were determined as the proportion of these amongst all included PLHIV-TB. A multivariate analysis was conducted to determine risk factors that were statistically associated with MDRTB, DRTB, RRTB and INH mono-resistant TB. Results Two hundred PLHIV were recruited. The prevalence (95% CI) of MDRTB, INH mono- resistance and RR resistance was 12.5% (7.9–17.1%), 9% (6.9–11.2%) and 2.5% (1.4–3.6%), respectively. The prevalence (95% CI) of MDRTB among new and relapsed patients was 8.8% (6.5–11.1%) and 23.1% (17.2–28.9%), respectively. Tuberculosis relapse was the only factor significantly associated with MDRTB, DRTB and INH mono-resistant TB. Conclusion We document a high prevalence of drug resistance to anti-TB drugs including MDRTB among PLHIV in our setting using Geno Type MTBDRplus directly on clinical specimens. This validates the WHO recommendation of performing routine rapid molecular resistance testing prior to initiating anti-TB treatment among all PLHIV with presumptive TB. Using rapid molecular testing especially Geno Type MTBDRplus (that detects resistance to INH and Rifampicin simultaneously) reduces the turn-around time helping in optimizing treatment.

Background: An association between increased incidence of acute myocardial infarction (AMI) and elevated levels of stored iron concentration was recently reported. The data in India regarding association between AMI and levels of serum ferritin are lacking. Objectives: To study the association between serum ferritin level and risk of AMI. Materials and Methods: The present case-control study was conducted from May 2016 to October 2017 on 64 patients aged ≥30 years of either sex who were diagnosed with AMI (group I) and 60 controls (group II). Patients who attended outpatient department of hospital for minor illnesses, routine health checkups, and persons accompanying patients were selected randomly as controls. The controls had no signs of AMI or coronary heart disease (CHD) on clinical examination and had normal electrocardiogram (ECG). Quantitative measurement of serum ferritin was done in all subjects. The Chi-square or Fisher’s exact test and unpaired t-test were used to compare the categorical and quantitative variables, respectively. The independent association of serum ferritin with AMI was tested using multivariate logistic regression analysis. Results: The mean serum ferritin level was significantly higher in group I (203.5 µg/L) as compared to group II (111.8 µg/L). In group I, 82.9% patients had serum ferritin ≥150 µg/L as compared to group II (15.0%) with p-value = 0.001. Multivariate analysis showed history of smoking, body mass index (BMI) >25 kg/m2 , serum ferritin levels >200 µg/L, and high-density lipoprotein (HDL) cholesterol level <35mg/dL were independent and significant determinants of AMI. Conclusions: There was an association between elevated serum ferritin levels with AMI.

Background The World Health Organization (WHO) recommends routine cryptococcal antigen (CrAg) screening in patients with advanced HIV disease initiating antiretroviral treatment (ART). India has yet to adopt this strategy as the burden of cryptococcal disease is unknown.Methods This was a prospective cohort study conducted between March 1, 2010 and March 1, 2017 at three private hospitals in Pune, India. All HIV-positive patients (symptomatic and asymptomatic) with CD4 counts ≤ 200 cells/µL were screened for serum cryptococcal antigen. Serum CrAg was measured using latex agglutination (LA) test. Both, ART naïve and ART experienced patients were included in the study. All HIV infected patients who were CrAg-positive were offered lumbar puncture (LP) and worked up for disseminated cryptococcal disease.ResultsA total of 785 HIV-positive patients (24.2% females) were included. Median age of cohort was 42 years (IQR, 35–49) and median CD4 count was 79 cells/mm3 (IQR, 37–82). 182/785(23.2%) patients were ART experienced. A total of 6.75% (53/785) of patients were CrAg positive in serum. Thirty-nine of 53 (73.6%) patients with positive serum cryptococcal antigen test had CD4 count ≤100 cells/mm3 while 14/53 (26.4%) had CD4 between 100 and 200 cells/mm3. Cerebrospinal fluid (CSF) CrAg was positive in 44/53(83%) patients. Two of 53(3.78%) had non-CNS, diffuse pulmonary cryptococcal disease and 7/53(13.2%) patients had isolated cryptococcal antigenemia. Patients with cryptococcal meningitis and crptococcal pulmonary disease were treated with Amphotericin-B plus oral Fluconazole. Patients with isolated cryptococcal antigenemia were treated with oral Fluconazole. Mortality at 6 months for patients with positive CrAg test was 22.6% (12/53).Conclusion We found 6.75% prevalence of cryptococcaemia amongst HIV patients with CD4 <200 cells/mm3. Given the high fatality rates observed, routine CrAg screening should be considered for all Indians with advanced HIV disease.Disclosures All authors: No reported disclosures.