Preventing opportunistic infections among human immunodeficiency virus-infected adults in African countries.

Grant, Alison D.; Kaplan, Jonathan E.; Cock, Kevin M. De

doi:10.4269/ajtmh.2001.65.810

Cited by 30 publications

(21 citation statements)

References 60 publications

(57 reference statements)

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“…In contrast, the ability of PPE-C (and its peptides) to distinguish between latent TB and incipient, subclinical TB would be of value in countries of TB endemicity where TB control is focused on detection and treatment only of patients with active TB. Preventive therapy with isoniazid has been shown to be beneficial in reducing the incidence of TB in both HIV Ϫ and HIV ϩ individuals and is especially recommended for HIV ϩ individuals (13,18). However, monotherapy in individuals with active TB runs the risk of fostering drug resistance (30), and no reliable tests that can differentiate between a truly latent infection and incipient, subclinical TB are available.…”

Section: Discussionmentioning

confidence: 99%

Immunogenicity of the Mycobacterium tuberculosis PPE55 (Rv3347c) Protein during Incipient and Clinical Tuberculosis

et al. 2005

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Approximately 5 to 10% of individuals who get infected with Mycobacterium tuberculosis progress to clinical tuberculosis (TB), whereas the remaining individuals develop a latent infection with the organism. Another 5 to 10% of these latently infected individuals reactivate their infection and progress to clinical TB during subsequent years/decades. In either case, active infection with M. tuberculosis is identified only when progression to bacteriologically detectable disease occurs. Thus, clinical TB, whether noncavitary paucibacillary or cavitary multibacillary disease, represents the late stages of a chronic disease process.Our studies of humoral immune responses elicited by M. tuberculosis at different stages of infection and disease progression have shown that the profile of antigenic proteins expressed by the in vivo bacteria that elicit antibodies correlates with the stage of the infection (21-23, 35-37, 45). Thus, purified-protein derivative-positive (PPD ϩ ) healthy individuals have antibodies to only a small subset (4-6) of the Ͼ100 culture filtrate proteins (CFP) of M. tuberculosis. In contrast, patients with noncavitary paucibacillary TB have antibodies directed against ϳ10 to 12 additional CFP antigens (35). As the disease progresses to the development of cavitary lesions, besides the presence of antibodies to the above-mentioned antigens, antibodies to an additional ϳ10 to 12 antigens appear. These results provide evidence that as M. tuberculosis adapts to different in vivo environments, the profile of antigenic proteins that are expressed changes. Evidence for adaptation by M. tuberculosis to different environmental conditions by altering gene/protein expression has also come from several other labs (3,11,12,29,32,41,42,47,49).M. tuberculosis is a slowly growing organism, and it takes weeks to months for the infection to progress to primary clinical TB. The time that elapses between the initiation of reactivation of latent infection and the manifestation of clinical TB is not known. The goal of the current studies was to identify antigenic proteins that are expressed during the asymptomatic, subclinical stages of infection when the in vivo M. tuberculosis bacilli replicate actively but the infection has not progressed to clinically identifiable disease (incipient, subclinical TB). Insight into these antigenic proteins will aid understanding of the host-pathogen interactions that lead to the progression of infection to clinical disease, and modulation of these host-pathogen interactions could potentially alter the outcome of infection. Moreover, antigenic proteins expressed during subclinical stages of active infection would also be useful for devising diagnostic markers that can differentiate between truly latent TB that is unlikely to progress to clinical disease and incipient, subclinical TB.

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Section: Discussionmentioning

confidence: 99%

Immunogenicity of the Mycobacterium tuberculosis PPE55 (Rv3347c) Protein during Incipient and Clinical Tuberculosis

et al. 2005

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“…In Uganda, the overall prevalence rate of HIV/AIDS is 7.0%, with an estimated 530,000 people infected (http://www.cdc.gov/nchstp/od/gap/countries/docs/ 04profiles/FY04%20OGAC%20Uganda.Final.pdf). Opportunistic infections (OI) present severe challenges to people living with HIV in Africa, where access to antiretroviral therapy is limited, palliative care is often suboptimal, and poor environmental conditions increase the risk of infection (Chaisson, 1998;Grant, 2001;Jeffrey, 1994). There is an urgent need for implementation of standardized, evidence-based measures to prevent OIs in adults and children with HIV .…”

Section: Introductionmentioning

confidence: 99%

Utilization of a basic care and prevention package by HIV-infected persons in Uganda

et al. 2008

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Opportunistic infections are the leading cause of mortality among HIV-infected people. Several simple interventions prevent illness, prolong life, or prevent HIV transmission from HIV-infected people in Africa. These include: cotrimoxazole prophylaxis; insecticide-treated bed nets; supplies for household water treatment and safe storage; materials promoting family voluntary counselling and testing (VCT); and condoms. We provided these interventions to adults and children with HIV who were members of the AIDS Support Organization in Uganda. To evaluate use of this basic care and prevention package, we surveyed a representative sample of 112 clients of TASO in their homes. Among respondents, 95% reported taking cotrimoxazole everyday, 89% said they had slept under a bednet the night before, 65% reported current treatment of household drinking water, 89% of sexually active respondents reported using condoms, and 96% reported family use of VCT. Household observations verified that use of cotrimoxazole, bednets, and water treatment products were consistent with reported use. This evaluation suggests successful distribution and use of basic care and prevention services at an AIDS organization in Uganda.

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“…Earlier studies with multiple serial serum samples from the same patients had shown that antibodies to the M. tuberculosis CFP preparation and to the semipurified native 81 (88)-kDa protein were detectable in serum samples obtained over several months during the time period prior to Seventy-five to 80% of the millions of HIV-infected individuals in sub-Saharan Africa and Southeast Asia are coinfected with M. tuberculosis, and TB is the leading cause of mortality and morbidity in these countries (2,3,8,21). Monotherapy with isoniazid is recommended by the Joint United Nations Programme on HIV/AIDS-World Health Organization to reduce the risk of TB in coinfected individuals, but administration of preventive monotherapy requires that active TB be excluded to reduce the risk of development of drug resistance (5,9,13). No reliable tests that can identify HIV ϩ individuals with incipient, subclinical TB are available, and exclusion is based on physical examination, patient history, and occasionally chest X-rays (5,13).…”

mentioning

confidence: 99%

“…Monotherapy with isoniazid is recommended by the Joint United Nations Programme on HIV/AIDS-World Health Organization to reduce the risk of TB in coinfected individuals, but administration of preventive monotherapy requires that active TB be excluded to reduce the risk of development of drug resistance (5,9,13). No reliable tests that can identify HIV ϩ individuals with incipient, subclinical TB are available, and exclusion is based on physical examination, patient history, and occasionally chest X-rays (5,13). Multidrug preventive therapy of all HIV ϩ individuals is not feasible, especially since repeated courses of preventive therapy or lifelong prophylaxis may be required (5,13 (1,6,8).…”

mentioning

confidence: 99%

Antigens of Mycobacterium tuberculosis Recognized by Antibodies during Incipient, Subclinical Tuberculosis

Singh

Dong

Belisle

et al. 2005

Clin Vaccine Immunol

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Preventing opportunistic infections among human immunodeficiency virus-infected adults in African countries.

Cited by 30 publications

References 60 publications

Immunogenicity of the Mycobacterium tuberculosis PPE55 (Rv3347c) Protein during Incipient and Clinical Tuberculosis

Immunogenicity of the Mycobacterium tuberculosis PPE55 (Rv3347c) Protein during Incipient and Clinical Tuberculosis

Utilization of a basic care and prevention package by HIV-infected persons in Uganda

Antigens of Mycobacterium tuberculosis Recognized by Antibodies during Incipient, Subclinical Tuberculosis

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