Advances in the understanding of Mycobacterium tuberculosis transmission in HIV-endemic settings

Peters, Julian; Andrews, Jason R.; Hatherill, Mark; Hermans, Sabine; Martínez, Leonardo; Schurr, Erwin; Heijden, Yuri van der; Wood, Robin; Rustomjee, Roxana; Kana, Bavesh D

doi:10.1016/s1473-3099(18)30477-8

Cited by 42 publications

(48 citation statements)

References 139 publications

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“…The propagation of multi-drug resistant (MDR) disease further imperils this approach; an assessment reinforced by growing evidence of the primary transmission of MDR Mtb strains (7)(8)(9)(10)(11)(12) and the knowledge that MDR-TB now accounts for more than one-quarter of all antimicrobial resistance (AMR) cases annually. These factors, together with the increasing appreciation that asymptomatic Mtb infections (with or without underlying pathology) might contribute to bacillary dissemination (13), have re-focused attention on Mtb transmission as a critical, but poorly understood, area for novel interventions in endemic regions (14)(15)(16). It is sobering, for example, that only 1-30 % of new Mtb infections can be linked to known TB cases -a disconnect which implies the existence of many unrecognized transmitters in TB endemic communities (17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Capture and visualization of liveMycobacterium tuberculosisbacilli from tuberculosis bioaerosols

Dinkele

Gessner

Koch

et al. 2019

Preprint

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authors contributed equally to this work. Abstract:The tuberculosis (TB) pandemic demands urgent interventions such as those designed to interrupt Mycobacterium tuberculosis (Mtb) transmission, a challenge exacerbated by our poor understanding of the events enabling successful transfer of infectious bacilli between hosts. To address this problem, we developed the Respiratory Aerosol Sampling Chamber (RASC), a personal clean-room equipped with high-efficiency filtration and sampling technologies that allow biosafe capture and isolation of particulate matter -including Mtb bacilli -released by patients during natural breathing and (non-induced) cough. Here, we demonstrate the use of DMNtrehalose labelling to detect and quantify live Mtb bacilli among complex bioaerosol samples arrayed in a bespoke nanowell device following capture in the RASC. A pilot study identified Mtb in more than 85 % of known TB patients, improving significantly on previous work which has relied on animal infection and cough sampling to estimate transmission events. Moreover, intrapatient comparisons of bioaerosol and sputum samples indicated that Mtb aerosols likely derive from a compartment other than sputum. These results support the utility of the RASC platform for research aimed at interrupting Mtb transmission, including the non-invasive detection of Mtbinfected individuals who are predicted to contribute to bacillary spread despite the absence of clinical symptoms.

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Section: Introductionmentioning

confidence: 99%

Capture and visualization of liveMycobacterium tuberculosisbacilli from tuberculosis bioaerosols

Dinkele

Gessner

Koch

et al. 2019

Preprint

Self Cite

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“…The understanding of the dynamics of TB infection and activation keeps improving and has evolved to describe a continuum between “latent” and “active” states that cover different scenarios between latent subclinical infection to clinically active disease . While much remains to be done in the quest for diagnostic technologies to provide a public health solution that can effectively find cases of TB infection at high risk of progression, the field of treatment has advanced significantly .…”

Section: Discussionmentioning

confidence: 99%

“…Tuberculosis (TB) is a leading cause of mortality among people living with HIV (PLHIV). This population contributes substantially to the global TB burden, with a higher risk of progressing from TB infection to disease than HIV‐negative people . In 2015, WHO launched the “End TB” strategy, setting ambitious targets of a 90% reduction in TB incidence and 95% reduction in mortality by 2035.…”

Section: Introductionmentioning

confidence: 99%

New opportunities in tuberculosis prevention: implications for people living with HIV

et al. 2020

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Introduction Tuberculosis (TB) is a leading cause of mortality among people living with HIV (PLHIV). An invigorated global END TB Strategy seeks to increase efforts in scaling up TB preventive therapy (TPT) as a central intervention for HIV programmes in an effort to contribute to a 90% reduction in TB incidence and 95% reduction in mortality by 2035. TPT in PLHIV should be part of a comprehensive approach to reduce TB transmission, illness and death that also includes TB active case‐finding and prompt, effective and timely initiation of anti‐TB therapy among PLHIV. However, the use and implementation of preventive strategies has remained deplorably inadequate and today TB prevention among PLHIV has become an urgent priority globally. Discussion We present a summary of the current and novel TPT regimens, including current evidence of use with antiretroviral regimens (ART). We review challenges and opportunities to scale‐up TB prevention within HIV programmes, including the use of differentiated care approaches and demand creation for effective TB/HIV services delivery. TB preventive vaccines and diagnostics, including optimal algorithms, while important topics, are outside of the focus of this commentary. Conclusions A number of new tools and strategies to make TPT a standard of care in HIV programmes have become available. The new TPT regimens are safe and effective and can be used with current ART, with attention being paid to potential drug‐drug interactions between rifamycins and some classes of antiretrovirals. More research and development is needed to optimize TPT for small children, pregnant women and drug‐resistant TB (DR‐TB). Effective programmatic scale‐up can be supported through context‐adapted demand creation strategies and the inclusion of TPT in client‐centred services, such as differentiated service delivery (DSD) models. Robust collaboration between the HIV and TB programmes represents a unique opportunity to ensure that TB, a preventable and curable condition, is no longer the number one cause of death in PLHIV.

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“…In 2018, the UN High-Level Meeting (UNHLM) on Tuberculosis incited the global efforts to prevent TB by setting renewed targets to provide TB preventive therapy (TPT) to 30 million people by 2020 including six million PLHIV. 15 , 17 …”

Section: Hiv-1 and Tb Co-infections In The Kingdom Of Saudi Arabiamentioning

confidence: 99%

HIV in the Kingdom of Saudi Arabia: Can We Change the Way We Deal with Co-Infections

Al-Mozaini

Alrahbeni

Dirar

et al. 2021

IDR

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The first incidence of acquired immunodeficiency syndrome (AIDS) from the Kingdom of Saudi Arabia (KSA) was reported back in 1984, and by the end of 2013, around 1509 patients were diagnosed with HIV infection. Recently in 2018, the Saudi ministry of health released that the incidence of HIV in Saudi Arabia is 3 cases of HIV for every 10,000 of the population. Having said that, the surveillance of HIV will face a range of challenges in KSA despite proper medical care, counseling, family planning, diagnostic, evaluation, and the use of effective anti-retroviral therapy. Patients who underwent anti-retroviral therapy showed significant reduction in morbidity as well as mortality. On the other hand, further targeted treatment and preventive strategies are warranted to control HIV co-infections in the KSA. In addition, progress towards meeting the WHO 90-90-90 goals for HIV not only at KSA but at the MENA region too, which is that of the population, 90% are diagnosed, 90% undergoing treatment, and 90% under viral control, is not being systematically monitored. In this review, we discuss the common co-infections with HIV infections that are reported in KSA, which when compared to international trends, it is similar for both viral hepatitis and tuberculosis. Although those co-infections exist, they are presented in different ratios and percentages when compared to the international reported data. These differences mandates defining and introducing new resilient methods of treatment and preventive measures. In this review, we offer an insight into healthcare policymakers to be compliant with UNAIDS 2020 vision program. We also discuss some of the gaps and recommendations to achieve the WHO 90-90-90 goal.

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Advances in the understanding of Mycobacterium tuberculosis transmission in HIV-endemic settings

Cited by 42 publications

References 139 publications

Capture and visualization of liveMycobacterium tuberculosisbacilli from tuberculosis bioaerosols

Capture and visualization of liveMycobacterium tuberculosisbacilli from tuberculosis bioaerosols

New opportunities in tuberculosis prevention: implications for people living with HIV

HIV in the Kingdom of Saudi Arabia: Can We Change the Way We Deal with Co-Infections

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