Michael Carter

First-line ART failure common among hospitalised HIV-positive people in sub-Saharan Africa

A large proportion of hospitalised HIV-positive people in sub-Saharan Africa have experienced the failure of first-line antiretroviral therapy (ART), according to a study published in the journal Clinical Infectious Diseases.

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Health system navigators didn't improve ART initiation or TB treatment completion rates among people newly diagnosed with HIV in Durban

An intervention using health system navigators, phone support and text message reminders did not improve rates of people living with HIV initiating antiretroviral therapy (ART) or completing treatment for tuberculosis (TB), investigators report in the Journal of Acquired Immune Deficiency Syndromes.

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Ugandan experience shows TB detection can be successfully incorporated into community HIV testing campaigns

Community health campaigns provide an opportunity to detect previously undiagnosed cases of tuberculosis (TB), investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. Research conducted in rural Uganda showed that incorporating TB screening into community health campaigns offering universal HIV testing led to the diagnosis of undetected TB cases. Overall, approximately 3000 patients need to be screened to identify one new case of TB, but among patients with HIV and chronic cough, the yield was one new TB diagnosis per 80 screens.

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Starting ART reduces TB risk for HIV-positive patients in South Africa

Starting antiretroviral therapy (ART) significantly reduces the risk of tuberculosis (TB) for patients in South Africa, investigators report in the online edition of AIDS. Overall, ART initiation was associated with a 45% reduction in TB risk, which was lower than the effectiveness observed in other research. The authors believe this difference is because of their rigorous methodology, which unlike earlier studies, took into account patients’ pre-treatment CD4 counts.

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ART during tuberculosis therapy reduces mortality risk for people with HIV

There is a high mortality rate among people living with HIV undergoing treatment for tuberculosis (TB), according to the results of a meta-analysis published in PLOS One. The mortality rate ranged between 8 and 14% but the risk of death was significantly lower for people who received antiretroviral treatment (ART) during their TB therapy.

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Bedaquiline as part of tailored therapy for MDR- and XDR-TB achieves impressive culture conversion rates

Bedaquiline combined with other active drugs has the potential to achieve high culture conversion rates in advanced MDR- and XDR-TB cases. However, it is crucial to follow carefully all patients for severe adverse events, even after bedaquiline discontinuation.

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Use of drug susceptibility testing to select therapy improves treatment outcomes in patients with MDR- and XDR-TB

New research published in the online edition of Clinical Infectious Diseases supports World Health Organization (WHO) recommendations for the use of drug susceptibility testing to select drugs for the treatment of drug-resistant tuberculosis. Drug susceptibility testing for ethambutol, pyrazinamide and second-line anti-tuberculosis (TB) treatment was shown to provide clinically useful information for the selection of treatment regimens for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). The chances of treatment success were increased between 1.7 and 4.6-fold when susceptibility testing showed that the use of an individual agent was appropriate.

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Study in South African township shows HIV-negative individuals often source of new TB cases in patients with HIV

HIV-negative individuals are an important source of new tuberculosis (TB) cases in HIV-positive patients, according to a study conducted in a South African township published in the online edition of the Journal of Infectious Diseases.

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HIV associated with increased risk of MDR-TB

HIV infection is associated with an increased risk of multi-drug-resistant tuberculosis (MDR-TB), results of a systematic review and meta-analysis published in PLOS ONE show. HIV increased the risk of MDR-TB by 24%. The analysis included 24 separate studies with a total patient population of 93,000. The investigators believe their findings have important implications for TB control programmes in terms of detection, appropriate treatment, infection control and follow-up.

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Cotrimoxazole prophylaxis neither reduces TB risk nor complicates TB diagnosis in people with HIV

Cotrimoxazole prophylaxis has no impact on incidence or detection of tuberculosis (TB) in people with HIV, a study published PLoS One shows. The prospective, observational study involved 2393 adult participants in Soweto, South Africa. All had a CD4 cell count below 350 cells/mm3. Participants taking cotrimoxazole prophylaxis actually had a higher risk of TB compared to participants not taking the treatment. But the authors believe this was due to residual confounding. Prophylaxis with the drug did not compromise TB diagnosis and had a protective effect in term of overall mortality.

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