Triple Trouble: the Role of Malnutrition in Tuberculosis and Human Immunodeficiency Virus Co-infection

Lettow, Monique van; Fawzi, Wafaie W.; Semba, P.H.; Semba, Richard D.

doi:10.1301/nr.2003.marr.81-90

Cited by 96 publications

(79 citation statements)

References 52 publications

(93 reference statements)

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“…1). Baseline characteristics of the 100 patients are shown in Table 1 2 , and 58% of patients were male. There were no differences in baseline characteristics across the randomized groups.…”

Section: Resultsmentioning

confidence: 99%

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Nutritional Supplementation Increases Rifampin Exposure among Tuberculosis Patients Coinfected with HIV

Jeremiah

Denti

Cosson

et al. 2014

Antimicrob Agents Chemother

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f Nutritional supplementation to tuberculosis (TB) patients has been associated with increased weight and reduced mortality, but its effect on the pharmacokinetics of first-line anti-TB drugs is unknown. 2 ) were randomized to receive nutritional supplementation during the intensive phase of TB treatment. Rifampin plasma concentrations were determined after 1 week and 2 months of treatment. The effects of nutritional supplementation, HIV, time on treatment, body weight, and SLCO1B1 rs4149032 genotype were examined using a population pharmacokinetic model. The model adjusted for body size via allometric scaling, accounted for clearance autoinduction, and detected an increase in bioavailability (؉14%) for the patients in the continuation phase. HIV coinfection in patients not receiving the supplementation was found to decrease bioavailability by 21.8%, with a median maximum concentration of drug in serum (C max ) and area under the concentration-time curve from 0 to 24 h (AUC 0 -24 ) of 5.6 g/ml and 28.6 g · h/ml, respectively. HIV-coinfected patients on nutritional supplementation achieved higher C max and AUC 0 -24 values of 6.4 g/ml and 31.6 g · h/ml, respectively, and only 13.3% bioavailability reduction. No effect of the SLCO1B1 rs4149032 genotype was observed. In conclusion, nutritional supplementation during the first 2 months of TB treatment reduces the decrease in rifampin exposure observed in HIV-coinfected patients but does not affect exposure in HIV-uninfected patients. If confirmed in other studies, the use of defined nutritional supplementation in HIV-coinfected TB patients should be considered in TB control programs. (This study has the controlled trial registration number ISRCTN 16552219.)

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Section: Resultsmentioning

confidence: 99%

“…T uberculosis (TB) is commonly associated with HIV and undernutrition in resource-limited settings (1,2). Worldwide, of the 8.6 million people who developed TB in 2012, 13% of them were HIV positive.…”

mentioning

confidence: 99%

Nutritional Supplementation Increases Rifampin Exposure among Tuberculosis Patients Coinfected with HIV

Jeremiah

Denti

Cosson

et al. 2014

Antimicrob Agents Chemother

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“…It is tempting to think that nutritional support, especially for malnourished patients with MDR-TB, might improve treatment success. The evidence to date to support such an intervention is limited, 29 so there is scope here to assess this through clinical trials and programmatic implementation.…”

Section: Public Health Action Unfavourable Outcomes In Mdr-tb In Indimentioning

confidence: 99%

Predictors of unfavourable treatment outcome in patients with multidrug-resistant tuberculosis in India

Nair

Velayutham

Kannan

et al. 2017

public health action

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“…TB is generally accepted as being closely linked to nutritional status, yet there is a lamentable lack of a solid evidence base on which to incor-porate nutritional interventions into clinical practice or community preventative strategies. Several reports have suggested protein energy malnutrition as a risk factor (52)(53)(54). Weight loss, cachexia, and anemia caused by inflammatory responses to the infection contribute further to the poor nutritional status of patients with TB.…”

Section: Some Unsolved Nutritional Questionsmentioning

confidence: 99%

New challenges in studying nutrition-disease interactions in the developing world

Prentice

Gershwin²,

Schaible

et al. 2008

J. Clin. Invest.

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Latest estimates indicate that nutritional deficiencies account for 3 million child deaths each year in less-developed countries. Targeted nutritional interventions could therefore save millions of lives. However, such interventions require careful optimization to maximize benefit and avoid harm. Progress toward designing effective life-saving interventions is currently hampered by some serious gaps in our understanding of nutrient metabolism in humans. In this Personal Perspective, we highlight some of these gaps and make some proposals as to how improved research methods and technologies can be brought to bear on the problems of undernourished children in the developing world.

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Triple Trouble: the Role of Malnutrition in Tuberculosis and Human Immunodeficiency Virus Co-infection

Cited by 96 publications

References 52 publications

Nutritional Supplementation Increases Rifampin Exposure among Tuberculosis Patients Coinfected with HIV

Nutritional Supplementation Increases Rifampin Exposure among Tuberculosis Patients Coinfected with HIV

Predictors of unfavourable treatment outcome in patients with multidrug-resistant tuberculosis in India

New challenges in studying nutrition-disease interactions in the developing world

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