HIV Coinfection in Multidrug- and Extensively Drug-Resistant Tuberculosis Results in High Early Mortality

Gandhi, Neel R.; Shah, Neha; Andrews, Jason R; Vella, Venanzio; Moll, Anthony; Scott, Michelle Pellissier; Weissman, Darren; Marra, Claudio; Lalloo, Umesh; Friedland, Gerald

doi:10.1164/rccm.200907-0989oc

Cited by 269 publications

(263 citation statements)

References 25 publications

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“…2) (111,263). The higher case-fatality rate of TB in HIV-infected individuals is likely due to a combination of factors associated with HIV coinfection: (i) the rapid progression of disease due to the failure of immune responses to restrict the growth of Mycobacterium tuberculosis, (ii) delayed diagnosis and treatment of TB infection due to atypical presentation and lower rates of sputum smear positivity (33,53,122), (iii) delayed diagnosis of HIV infection due to stigma or insufficient uptake of HIV testing in TB clinics (122,262), (iv) delayed start or lack of access to combination antiretroviral therapy (ART) (122), and (v) higher rates of multidrug-resistant (MDR) TB (MDR-TB) leading to a delayed initiation of effective therapy (104). Deaths due to TB accounted for one-quarter of the estimated 2 million HIV-related deaths worldwide in 2008, and TB is the leading cause of death for people living with HIV in low-and middle-income countries (155,250,262,263).…”

Section: Scale Of the Problem: Millions Affected And Millions Of Livementioning

confidence: 99%

“…Gandhi et al investigated the prevalence rates of MDR-TB and XDR-TB in a region with HIV prevalence rates of 20% in maternity wards and 37% among women receiving antenatal care (103,104). Of the 1,539 patients tested, 542 (35%) had culture-positive TB, with MDR-TB in 221 (41%) of those with culture-positive TB.…”

Section: Drug-resistant Tuberculosis and Hiv: A Deadly Syndemicmentioning

confidence: 99%

“…A subsequent retrospective study of all patients with MDR-TB or XDR-TB from Tugela Ferry from 2005 to 2007 found that of the 272 MDR-TB and 382 XDR-TB cases, 90% and 98% were coinfected with HIV with median CD4 counts of 41 cells/l and 36 cells/l and median HIV viral loads of 160,000 and 135,500 log 10 copies/ml, respectively (103,104). The majority of patients were not receiving ART at the time of TB diagnosis.…”

Section: Drug-resistant Tuberculosis and Hiv: A Deadly Syndemicmentioning

confidence: 99%

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HIV and Tuberculosis: a Deadly Human Syndemic

2011

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SUMMARY 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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Section: Scale Of the Problem: Millions Affected And Millions Of Livementioning

confidence: 99%

Section: Drug-resistant Tuberculosis and Hiv: A Deadly Syndemicmentioning

confidence: 99%

Section: Drug-resistant Tuberculosis and Hiv: A Deadly Syndemicmentioning

confidence: 99%

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HIV and Tuberculosis: a Deadly Human Syndemic

2011

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“…При сравнении пациентов с ШЛУ и МЛУ оказалось, что единственным существенным фактором риска ШЛУ туберкулеза является ВИЧ инфекция [24]. [26].…”

Section: обзорыunclassified

Multi-drug resistant tuberculosis and HIV-infection

Боровицкий¹

2013

Pulʹmonologiâ (Mosk.)

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Туберкулез с широкой лекарственной устойчивостью микобактерий и ВИЧ инфекцияФедеральное казенное учреждение "Лечебное исправительное учреждение № 12" Управления федеральной службы исполнения наказаний РФ по Кировской области: 613040, Кировская обл., г. Кирово Чепецк V.S.Borovitsky Multi drug resistant tuberculosis and HIV infectionKey words: tuberculosis, multi drug resistance, HIV infection Ключевые слова: туберкулез, широкая лекарственная устойчивость, ВИЧ инфекция. Боровицкий В.С. Туберкулез с широкой лекарственной устойчивостью микобактерий и ВИЧ инфекция 110Пульмонология 2'2013 были пролечены 48 таких пациентов, причем в боль шинстве случаев -это ВИЧ инфицированные со средним временем выживания 10,8 мес. [19].Сообщение об одном из первых наблюдений ШЛУ у пациентов с ВИЧ появилось в ЮАР: с нояб ря 2003 г. по январь 2005 г. у 77 из 128 пациентов вы явлен МЛУ туберкулез, у 26 -пред ШЛУ, у 5 -ШЛУ туберкулез. С помощью филогенетического анализа МБТ было продемонстрировано пошаговое развитие ЛУ, несмотря на лечение, и показано, что существующие меры контроля над туберкулезом с ЛУ неадекватны [20].Также в Западной Капской провинции (ЮАР), в регионе, где отмечались случаи МЛУ туберкулеза, с октября 2006 г. по январь 2008 г. ретроспективно изучалась когорта из первых пациентов с ШЛУ ту беркулезом. Пациенты (n = 206) были госпитализи рованы для лечения, пока не были получены отрица тельные результаты посева мокроты, 65 пациентов со ШЛУ туберкулезом умерли до начала лечения. Среди 195 пациентов, до лечения прошедших обсле дование на ВИЧ, 108 (55,4 %) были ВИЧ инфициро ванными, 86 (44,1 %) умерли в течение 1 го года от начала химиотерапии. Выживаемость ВИЧ положи тельных пациентов и больных, получающих высоко активную антиретровирусную терапию (ВААРТ) примерно соответствовала таковой у ВИЧ отрица тельных. Как ни странно, пациенты без ВИЧ инфек ции имели более серьезные побочные эффекты от ле чения, требующие его прекращения, чем с ВИЧ, независимо от использования ВААРТ [21].По сообщению из госпиталя Kwazulu Natal (ЮАР), ретроспективно (август 2002 г. -февраль 2008 г.) в 4 провинциях Южной Африки были про анализированы данные когорты пациентов (n = 227) старше 16 лет с ШЛУ туберкулезом, подтвержден ным методом посева мокроты: из 195 пациентов 21 умер прежде чем было начато лечение, 174 (из них 82 -с ВИЧ инфекцией) прошли курс лечения, 62 (36 %) умерли в течение срока наблюдения. Число летальных исходов достоверно не различалось у па циентов с ВИЧ инфекцией и без таковой: 34 (41 %) из 82 и 28 (30 %) из 92 (p = 0,13) соответственно. Лечение моксифлоксацином, МЛУ МБТ, прежде до казанная культурально (посевом мокроты), и коли чество ПТП, используемых в режиме химиотерапии, не влияли на показатели смертности. Меньшее число смертельных случаев было среди пациентов с ВИЧ инфекцией, получающих противовирусную тера пию. У 33 (19 %) из 174 больных произошло усиле ние ЛУ МБТ в виде формирования ШЛУ, из них у 23 (70 %) это произошло в течение 6 мес. после начала лечения [22].В том же госпитале с января 2005 г. по сентябрь 2008 г. и...

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“…Similarly, a post mortem study assessing causes of death histologically and with mycobaterial and bacterial cultures showed that TB contributed to death in 17 of 25 adults receiving ART at the time of death (65). Extremely drug-resistant TB carries a very poor prognosis, particularly in HIV-infected adults, 51% of whom were reported to have died within 30 days of its diagnosis (66), and in those who survived long enough to initiate XDR treatment, 55% died while receiving treatment (67).…”

Section: Tb Mortality and Its Preventionmentioning

confidence: 99%

Epidemiology of Tuberculosis and HIV: Recent Advances in Understanding and Responses

Martinson¹,

Hoffmann²,

Chaisson³

2011

Proceedings of the American Thoracic Society

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Although tuberculosis (TB) continues to cause enormous suffering and overwhelm health care systems in areas with high HIV prevalence, there have been a number of recent significant advances in knowledge regarding the epidemiology, management, and control of HIV-related TB. TB remains the most common serious opportunistic infection in people with HIV infection and the leading cause of death. However, there is some reason for optimism. First, two trials addressing when to start antiretroviral therapy (ART) in HIV-infected adults with newly diagnosed TB have shown that earlier initiation of ART reduces mortality significantly. Second, there is trial evidence of efficacy in giving long-term isoniazid preventive treatment (IPT) to HIV-infected adults in high HIV-prevalence settings where TB reinfection is frequent (much like cotrimoxazole). Third, the search for an inexpensive, rapid, sensitive, and specific TB diagnostic that is able to replace smear and delayed mycobacterial culture has yielded promising results. Responding to massive TB epidemics in high HIVprevalence settings, the World Health Organization has supplemented its directly observed treatment short-course strategy with one called the 3I's to actively screen and diagnose TB cases (intensified case finding), prevent new cases of TB with IPT, and prevent transmission of TB in congregate settings such as hospitals and clinics (infection control). Combating TB in high HIV-prevalence settings requires rapid and massive implementation of the 3I's with initiation of antiretrovirals and more effective efforts to prevent new HIV infections.

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HIV Coinfection in Multidrug- and Extensively Drug-Resistant Tuberculosis Results in High Early Mortality

Abstract: Mortality from MDR and XDR TB in this high HIV-prevalence region is extraordinarily high, particularly within the first 30 days. Efforts to reduce mortality must focus on earlier diagnosis and early initiation of second-line TB and antiretroviral therapy.

Cited by 269 publications

References 25 publications

HIV and Tuberculosis: a Deadly Human Syndemic

HIV and Tuberculosis: a Deadly Human Syndemic

Multi-drug resistant tuberculosis and HIV-infection

Epidemiology of Tuberculosis and HIV: Recent Advances in Understanding and Responses

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