scholarly journals Urine Lipoarabinomannan Testing in Adults With Advanced Human Immunodeficiency Virus in a Trial of Empiric Tuberculosis Therapy

2021 ◽  
Author(s):  
Mitch M Matoga ◽  
Gregory P Bisson ◽  
Amita Gupta ◽  
Sachiko Miyahara ◽  
Xin Sun ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Clinical Symptoms ◽  
Preventive Therapy ◽  
Hiv Positive ◽  
Kaplan Meier ◽  
Immunodeficiency Virus ◽  
Hiv Positive Adults ◽  
Intent To Treat ◽  
Aids Clinical Trials ◽  
Tuberculosis Therapy

Abstract Background The urine lipoarabinomannan (LAM) antigen test is a tuberculosis (TB) diagnostic test with highest sensitivity in individuals with advanced human immunodeficiency virus (HIV). Its role in TB diagnostic algorithms for HIV-positive outpatients remains unclear. Methods The AIDS Clinical Trials Group (ACTG) A5274 trial demonstrated that empiric TB therapy did not improve 24-week survival compared to isoniazid preventive therapy (IPT) in TB screen–negative HIV-positive adults initiating antiretroviral therapy with CD4 counts <50 cells/µL. Retrospective LAM testing was performed on stored urine obtained at baseline. We determined the proportion of LAM-positive participants and conducted modified intent-to-treat analysis excluding LAM-positive participants to determine the effect on 24-week survival, TB incidence, and time to TB using Kaplan-Meier method. Results A5274 enrolled 850 participants; 53% were male and the median CD4 count was 18 (interquartile range, 9–32) cells/µL. Of the 850, 566 (67%) had LAM testing (283 per arm); 28 (5%) were positive (21 [7%] and 7 [2%] in the empiric and IPT arms, respectively). Of those LAM-positive, 1 participant in each arm died and 5 of 21 and 0 of 7 in empiric and IPT arms, respectively, developed TB. After excluding these 28 cases, there were 19 and 21 deaths in the empiric and IPT arms, respectively (P = .88). TB incidence remained higher (4.6% vs 2%, P = .04) and time to TB remained faster in the empiric arm (P = .04). Conclusions Among outpatients with advanced HIV who screened negative for TB by clinical symptoms, microscopy, and Xpert testing, LAM testing identified an additional 5% of individuals with TB. Positive LAM results did not change mortality or TB incidence.

scholarly journals Incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos referral hospital, Northwest Ethiopia: a retrospective record review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Belisty Temesgen ◽  
Getiye Dejenu Kibret ◽  
Nakachew Mekonnen Alamirew ◽  
Mamaru Wubale Melkamu ◽  
Yitbarek Tenaw Hibstie ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
Preventive Therapy ◽  
Hemoglobin Level ◽  
Disease Stage ◽  
Hiv Positive ◽  
Immunodeficiency Virus ◽  
Hiv Positive Adults ◽  
Record Review

Abstract Background Tuberculosis is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus are attributed to tuberculosis. Despite this evidence, in Ethiopia, there is a scarcity of information regarding the incidence and predictors of tuberculosis among people living with HIV. Thus, this study assessed the incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy. Methods This study was a retrospective record review including 544 HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital between January 1, 2012 and December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from antiretroviral intake and follow-up forms. Cox-proportional hazards regression model was fitted and Cox-Snell residual test was used to assess the goodness of fit. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of tuberculosis. Results In the final analysis, a total of 492 HIV-positive adults were included, of whom, 83 (16.9%) developed tuberculosis at the time of follow-up. This study found that the incidence of tuberculosis was 6.5 (95% CI: 5.2, 8.0) per 100-person-years (PY) of observation. Advanced World Health Organization clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking Isonized Preventive Therapy (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be the predictors of tuberculosis. Conclusion The study found that there was a high rate of tuberculosis occurrence as compared to previous studies. Baseline opportunistic infections, being ambulatory and bedridden, advanced disease stage, low hemoglobin level, and not taking Isonized Preventive Therapy were found to be the predictors of tuberculosis. Therefore, early detection and treatment of opportunistic infections like tuberculosis should get a special attention.

scholarly journals Standardized Urine-Based Tuberculosis (TB) Screening With TB-Lipoarabinomannan and Xpert MTB/RIF Ultra in Ugandan Adults With Advanced Human Immunodeficiency Virus Disease and Suspected Meningitis

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Fiona V Cresswell ◽  
Jayne Ellis ◽  
Enock Kagimu ◽  
Ananta S Bangdiwala ◽  
Michael Okirwoth ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Odds Ratio ◽  
Virus Disease ◽  
Extrapulmonary Tuberculosis ◽  
Hiv Positive ◽  
Systematic Screening ◽  
Immunodeficiency Virus ◽  
Cell Pellet ◽  
Hiv Positive Adults ◽  
Advanced Hiv Disease

Abstract Background Diagnosis of extrapulmonary tuberculosis (TB) remains challenging. We sought to determine the prevalence of disseminated TB by testing urine with TB-lipoarabinomannan (TB-LAM) lateral flow assay and Xpert MTB/RIF Ultra (Ultra) in hospitalized adults. Methods We prospectively enrolled human immunodeficiency virus (HIV)-positive adults with suspected meningitis in Uganda during 2018–2020. Participants underwent standardized urine-based TB screening. Urine (60 mcL) was tested with TB-LAM (Alere), and remaining urine was centrifuged with the cell pellet resuspended in 2 mL of urine for Xpert Ultra testing. Results We enrolled 348 HIV-positive inpatients with median CD4 of 37 cells/mcL (interquartile range, 13–102 cells/mcL). Overall, 26% (90 of 348; 95% confidence interval [CI], 21%–30%) had evidence of disseminated TB by either urine assay. Of 243 participants with both urine TB-LAM and Ultra results, 20% (48 of 243) were TB-LAM-positive, 12% (29 of 243) were Ultra-positive, and 6% (14 of 243) were positive by both assays. In definite and probable TB meningitis, 37% (14 of 38) were TB-LAM-positive and 41% (15 of 37) were Ultra-positive. In cryptococcal meningitis, 22% (40 of 183) were TB-LAM-positive and 4.4% (6 of 135) were Ultra-positive. Mortality trended higher in those with evidence of disseminated TB by either assay (odds ratio = 1.44; 95% CI, 0.83–2.49; P = .19) and was 6-fold higher in those with definite TB meningitis who were urine Ultra-positive (odds ratio = 5.67; 95% CI, 1.13–28.5; P = .04). Conclusions In hospitalized Ugandans with advanced HIV disease and suspected meningitis, systematic screening with urine TB-LAM and Ultra found a high prevalence of urine TB test positivity (26%). In those with TB meningitis, urine tests were positive in over one third. There was little concordance between Ultra and TB-LAM, which warrants further investigation.

scholarly journals Incidence of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia: A retrospective record review

2019 ◽  
Author(s):  
Belisty Temesgen ◽  
Getiye Dejenu Kibret ◽  
Nakachew Mekonnen Alamirew ◽  
Animut Alebel
Keyword(s):  
Human Immunodeficiency Virus ◽  
Opportunistic Infections ◽  
Hemoglobin Level ◽  
Disease Stage ◽  
Hiv Positive ◽  
Retrospective Record Review ◽  
Immunodeficiency Virus ◽  
Hiv Positive Adults ◽  
Record Review

Abstract Background: Tuberculosis is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus are attributed to tuberculosis. Despite this fact, in Ethiopia, particularly in our study area there is a scarcity of information regarding the incidence and predictors of TB among peoples living with HIV. Thus, this study aimed to assess the incidence and predictors of tuberculosis among HIV-positive adults on ART. Methods: A retrospective record review was conducted among 544 HIV-positive adults on ART at Debre Markos Referral Hospital from January 1, 2012 to December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from ART intake and follow-up forms. Data were entered using Epi-Data version 4.2 and analyzed using STATA Version 13. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of the time to develop TB. Results: Among 492 HIV-positive adults included in the final analysis, 16.9% developed TB at the time of follow up. The incidence rate of TB was found to be 6.5 (95%CI: 5.2, 8.0) per 100-person years of observation. Advanced WHO clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking IPT (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be the predictors of TB. Conclusion: In this study, a high incidence rate of TB was observed among HIV-positive adults. Advanced WHO clinical disease stage (III and IV), being ambulatory and bedridden, baseline opportunistic infections, low hemoglobin level, and not taking IPT were found to be the predictors of TB. Keywords: HIV, Incidence, Predictors, TB

scholarly journals Incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia: A retrospective record review

2019 ◽  
Author(s):  
Belisty Temesgen ◽  
Getiye Dejenu Kibret ◽  
Nakachew Mekonnen Alamirew ◽  
Mamaru Wubale Melkamu ◽  
Yitbarek Tenaw Hibstie ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
Preventive Therapy ◽  
Disease Stage ◽  
Hiv Positive ◽  
Immunodeficiency Virus ◽  
Hiv Positive Adults ◽  
Debre Markos ◽  
Record Review

Abstract Background: Tuberculosis is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus are attributed to tuberculosis. Despite this evidence, in Ethiopia, there is a scarcity of information regarding the incidence and predictors of tuberculosis among people living with HIV. Thus, this study assessed the incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy. Methods: This study was a retrospective record review including 544 HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital between January 1, 2012 and December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from antiretroviral intake and follow-up forms. Cox-proportional hazards regression model was fitted and Cox-Snell residual test was used to assess the goodness of fit. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of tuberculosis. Results: In the final analysis, a total of 492 HIV-positive adults were included, of whom, 83 (16.9%) developed tuberculosis at the time of follow-up. This study found that the incidence of tuberculosis was 6.5 (95% CI: 5.2, 8.0) per 100-person-years (PY) of observation. Advanced World Health Organization clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking Isonized Preventive Therapy (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be the predictors of tuberculosis. Conclusion: The study found that there was a high rate of tuberculosis occurrence as compared to previous studies. Baseline opportunistic infections, being ambulatory and bedridden, advanced disease stage, low hemoglobin level, and not taking Isonized Preventive Therapy were found to be the predictors of tuberculosis. Therefore, early detection and treatment of opportunistic infections like tuberculosis should get a special attention. Keywords: Debre Markos, HIV, Incidence, Predictors, tuberculosis

scholarly journals Incidence of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia: A retrospective cohort study

2019 ◽  
Author(s):  
Belisty Temesgen ◽  
Getiye Dejenu Kibret ◽  
Nakachew Mekonnen Alamirew ◽  
Animut Alebel
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Opportunistic Infections ◽  
Hemoglobin Level ◽  
Disease Stage ◽  
Hiv Positive ◽  
Immunodeficiency Virus ◽  
Hiv Positive Adults

Abstract Background: Tuberculosis is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus are attributed to tuberculosis. Despite this fact, in Ethiopia, particularly in our study area there is a scarcity of information regarding the incidence and predictors of TB among peoples living with HIV. Thus, this study aimed to assess the incidence and predictors of tuberculosis among HIV positive adults. Methods: An institution based retrospective cohort study was conducted among 544 HIV-positive adults on ART at Debre Markos Referral Hospital from January 1, 2012 to December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from ART intake and follow-up forms. Data were entered using Epi-Data version 4.2 and analyzed using STATA Version 13. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of the time to develop TB. Results: Among 492 HIV-positive adults included in the final analysis, 16.9% of them developed TB at the time of follow up. The incidence rate of TB was found to be 6.5 (95%CI: 5.2, 8.0) per 100-person years. Advanced WHO clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking IPT (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be predictors of the time to develop TB. Conclusion: In this study, a high incidence rate of TB was observed among HIV-positive adults. Advanced HIV disease stage (III and IV), being ambulatory and bedridden, having opportunistic infections, having a low hemoglobin level, and not taking IPT were found to be predictors of the time to develop TB. Keywords: HIV, Incidence, Predictors, TB

scholarly journals A Randomized Controlled Trial of Isoniazid to Prevent Mycobacterium tuberculosis Infection in Kenyan Human Immunodeficiency Virus–Exposed Uninfected Infants

2020 ◽  
Author(s):  
Sylvia M LaCourse ◽  
Barbra A Richardson ◽  
John Kinuthia ◽  
A J Warr ◽  
Elizabeth Maleche-Obimbo ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Mycobacterium Tuberculosis ◽  
High Risk ◽  
Adverse Events ◽  
Controlled Trial ◽  
Preventive Therapy ◽  
Infection Prevalence ◽  
Mycobacterium Tuberculosis Infection ◽  
Immunodeficiency Virus ◽  
Exposed Uninfected

Abstract Background Human immunodeficiency virus (HIV)–exposed uninfected (HEU) infants in endemic settings are at high risk of tuberculosis (TB). For infants, progression from primary Mycobacterium tuberculosis (Mtb) infection to TB disease can be rapid. We assessed whether isoniazid (INH) prevents primary Mtb infection. Methods We conducted a randomized nonblinded controlled trial enrolling HEU infants 6 weeks of age without known TB exposure in Kenya. Participants were randomized (1:1) to 12 months of daily INH (10 mg/kg) vs no INH. Primary endpoint was Mtb infection at end of 12 months, assessed by interferon-γ release assay (QuantiFERON-TB Gold Plus) and/or tuberculin skin test (TST, added 6 months after first participant exit). Results Between 15 August 2016 and 6 June 2018, 416 infants were screened, with 300 (72%) randomized to INH or no INH (150 per arm); 2 were excluded due to HIV infection. Among 298 randomized HEU infants, 12-month retention was 96.3% (287/298), and 88.9% (265/298) had primary outcome data. Mtb infection prevalence at 12-month follow-up was 10.6% (28/265); 7.6% (10/132) in the INH arm and 13.5% (18/133) in the no INH arm (7.0 vs 13.4 per 100 person-years; hazard ratio, 0.53 [95% confidence interval {CI}, .24–1.14]; P = .11]), and driven primarily by TST positivity (8.6% [8/93] in INH and 18.1% [17/94] in no INH; relative risk, 0.48 [95% CI, .22–1.05]; P = .07). Frequency of severe adverse events was similar between arms (INH, 14.0% [21/150] vs no INH, 10.7% [16/150]; P = .38), with no INH-related adverse events. Conclusions Further studies evaluating TB preventive therapy to prevent or delay primary Mtb infection in HEU and other high-risk infants are warranted. Clinical Trials Registration NCT02613169.

scholarly journals Influence of boarding secondary school environment on HIV positive students in South Western Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Raymond Bernard Kihumuro ◽  
David Jolly Muganzi ◽  
Elton George Wandira ◽  
Racheal Alinaiswe ◽  
Jovitah Joselyne Nanyunja ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Secondary School ◽  
Secondary Schools ◽  
School Environment ◽  
Coping Mechanisms ◽  
Hiv Positive ◽  
Key Informants ◽  
Immunodeficiency Virus ◽  
Negative Coping ◽  
Depth Interviews

Abstract Background The number of human immunodeficiency virus (HIV) positive adolescents in secondary school has increased over the years. Little is known on how the students cope to the pressures and demands of their academic and health lives in the boarding secondary schools. This study explored the factors surrounding their anti-retroviral therapy adherence as well as their experiences. Methods We did a qualitative study that employed in-depth interviews amongst purposively selected 19 HIV positive adolescent students in boarding secondary school and seven key informants. Key informants were members of boarding secondary school staff directly taking care of the adolescents living with human immune virus and had spent at least two academic terms in that school. The study participants were recruited from four health facilities in Bushenyi district, southwestern Uganda, and key informants from five boarding secondary schools in Bushenyi. These were engaged in in-depth interviews using an interview guide. Data was transcribed, coded and the content analyzed thematically. Results Adolescents living with human immunodeficiency virus in boarding secondary school face challenges similar to adolescents outside boarding school settings. However, some challenges are unique to them. Students faced numerous barriers which made it difficult to adhere to their medication. Stigmatization in its different forms was also a major challenge amongst students. Willingness disclosure of serostatus was beneficial to the students since it guaranteed support while at school; facilitating adherence and better living. However, students were uneasy to disclose their status. Some students adopted negative coping mechanisms such as telling lies, escaping from school, and class to access medication. Conclusions Adolescents in boarding secondary schools face similar challenges as compared to their counterparts with some being unique to them. Few school mechanisms help these students to cope while at school. Limited disclosure has proven useful but some adolescents have opted not to disclose their status and hence used negative coping mechanisms. These challenges need to be addressed and a safe environment to encourage limited disclosure should be made.

Pneumocystis carinii infection in bilateral aural polyps in a human immunodeficiency virus-positive patient

2002 ◽  
Vol 116 (4) ◽  
pp. 288-290 ◽  
Author(s):  
C. V. Praveen ◽  
R. M. Terry ◽  
M. Elmahallawy ◽  
C. Horsfield
Keyword(s):  
Human Immunodeficiency Virus ◽  
Opportunistic Infection ◽  
Pneumocystis Carinii ◽  
Lymphatic Vessels ◽  
Blood Stream ◽  
Positive Patient ◽  
Hiv Positive ◽  
Immunodeficiency Virus ◽  
History Of ◽  
Pneumocystis Carinii Infection

Pneumocystis carinii is an opportunistic infection found in patients with impaired immunity. Under favourable conditions the parasite can spread via the blood stream or lymphatic vessels and cause extrapulmonary dissemination. We report a case of P carinii infection presenting as bilateral aural polyps, otitis media and mastoiditis in human immunodeficiency (HIV)-positive patient with no history of prior or concomitant P carinii infection.

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