The Role of QuantiFERON®-TB Gold and Tuberculin Skin Test as Diagnostic Tests for Intraocular Tuberculosis in HIV-Positive and HIV-Negative Patients in South Africa

Five hundred ninety-two drug users (IDUs) from community settings in San Francisco and Oakland, California, were screened for tuberculosis using the tuberculin skin test, as well as for skin test anergy using two controls: mumps antigen and either tetanus toxoid or Candida. Those nonresponsive to one skin test were more likely to be nonresponsive to another, even after stratifying by HIV status. Skin test anergy (defined as nonresponse to the tuberculin skin test and to both controls) occurred in 37% of HIV-positive and 11% of HIV-negative IDUs (p<0.001). Among HIV-negative IDUs, anergy was associated with city of residence (p<0.001), use of cocaine by any route in the last 30 days (p=0.026) and use of speedballs (heroin and cocaine) by any route in the last 30 days (p=0.053). Skin test anergy in this population of IDUs may reflect more generalized defects in the delayed hypersensitivity response. Other exposures besides HIV which occur in IDUs may result in impaired cellular immunity.

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Estimating the annual risk of infection with Mycobacterium tuberculosis among adolescents in Western Kenya in preparation for TB vaccine trials

10.21203/rs.2.9381/v2 ◽

2019 ◽

Author(s):

Videlis Nduba ◽

Anna H. van’t Hoog ◽

Annefleur de Bruijn ◽

Ellen M.H. Mitchell ◽

Kayla Laserson ◽

...

Keyword(s):

Tuberculin Skin Test ◽

Skin Test ◽

Positive Tuberculin Skin Test ◽

Target Group ◽

Hiv Positive ◽

Tuberculous Infection ◽

Western Kenya ◽

Vaccine Trials ◽

Annual Risk ◽

Hiv Negative

Abstract Background: Adolescents are a prime target group for tuberculosis (TB) vaccine trials that include prevention of infection (POI). The BCG vaccine is given at birth and does not prevent TB infection. TB infection, a critical endpoint for POI vaccine trials would need to be documented to estimate sample sizes in target populations. Methods: Adolescents aged 12-18 years of age were enrolled in an area under continuous demographic surveillance. A tuberculin skin test (TST) survey was conducted as part of a study on TB prevalence and incidence. All adolescents got TSTs at enrolment and returned after 72 hours for reading. A TST of ≥10mm if HIV negative or ≥ 5mm if HIV positive, was considered positive. Results: Of 5004 adolescents enrolled, 4808 (96%) returned for TST readings. Of these 2327(48.4%) were female, 861 (17.9%) had no BCG scar, and 23 (0.5%) were HIV positive. The baseline prevalence of tuberculous infection was 32% (95% CI 29-35%) with a corresponding ARTI of 2.6% (95% CI 2.2-3.1%). Male gender (OR 1.3, 95%CI 1.2,1.5), having a BCG scar (OR 1.4,95%CI 1.3,1.7) and not being enrolled in school (OR 1.8, 95%CI 1.4,2.3) were independent predictors of a positive tuberculin skin test at baseline. Conclusion: We conclude that the high TB transmission rates we found in this study, suggest that adolescents in this region may be an appropriate target group for TB vaccine trials including TB vaccine trials aiming to prevent infection.

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Tubercular meningitis with hydrocephalus with HIV co-infection: role of cerebrospinal fluid diversion procedures

Journal of Neurosurgery ◽

10.3171/2014.12.jns14257 ◽

2015 ◽

Vol 122 (5) ◽

pp. 1087-1095 ◽

Cited By ~ 12

Author(s):

Raman Mohan Sharma ◽

Nupur Pruthi ◽

Arivazhagan Arimappamagan ◽

Sampath Somanna ◽

Bhagavathula Indira Devi ◽

...

Keyword(s):

Hiv Positive ◽

Short Term ◽

Tubercular Meningitis ◽

Term Outcome ◽

Long Term Outcome ◽

Shunt Placement ◽

Poor Outcome ◽

Hiv Negative

OBJECT Hydrocephalus is one of the commonest complications of tubercular meningitis (TBM), and its incidence is increasing with the HIV epidemic. Literature evaluating the role of ventriculoperitoneal shunts in HIV-positive patients with TBM and their long-term prognosis is scarce. METHODS Between June 2002 and October 2012, 30 HIV-positive patients with TBM and hydrocephalus underwent ventriculoperitoneal shunt placement. Thirty age-, sex-, and grade-matched HIV-negative patients with TBM and hydrocephalus were randomly selected as the control group. Outcome was analyzed at discharge (short-term outcome) and at follow-up (long-term outcome). Univariate and multivariate analyses were performed to look for predictors of outcome; p < 0.05 was considered significant. RESULTS There were no differences in the clinical, radiological, or biochemical parameters between the 2 groups. Short-term outcome was better in the HIV-negative group (76.7% improvement) than in the HIV-positive group (70%). However, the long-term outcome in HIV-positive patients was very poor (66.7% mortality and 76.2% poor outcome) compared with HIV-negative patients (30.8% mortality and 34.6% poor outcome). Seropositivity for HIV is an independent predictor of poor outcome both in univariate and multivariate analyses (p = 0.038). However, in contrast to previous reports, of 5 patients with TBM in good Palur grades among the HIV-positive patients, 4 (80%) had good outcome following shunt placement. CONCLUSIONS The authors recommend that shunt treatment should not be performed in HIV-positive patients in poor Palur grade with hydrocephalus. A trial of external ventricular drainage should be undertaken in such patients, and shunt treatment should be performed only if there is any improvement. However, HIV-positive patients in good Palur grades should undergo VP shunt placement, as these patients have better outcomes than previously reported.

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Screening for developmental disabilities in HIV positive and HIV negative children in South Africa: Results from the Asenze Study

PLoS ONE ◽

10.1371/journal.pone.0199860 ◽

2018 ◽

Vol 13 (7) ◽

pp. e0199860 ◽

Cited By ~ 5

Author(s):

Justin Knox ◽

Stephen M. Arpadi ◽

Shuaib Kauchali ◽

Murray Craib ◽

Jane D. Kvalsvig ◽

...

Keyword(s):

South Africa ◽

Developmental Disabilities ◽

Hiv Positive ◽

Hiv Negative

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Performance of verbal autopsy methods in estimating HIV-associated mortality among adults in South Africa

BMJ Global Health ◽

10.1136/bmjgh-2018-000833 ◽

2018 ◽

Vol 3 (4) ◽

pp. e000833 ◽

Cited By ~ 1

Author(s):

Aaron S Karat ◽

Noriah Maraba ◽

Mpho Tlali ◽

Salome Charalambous ◽

Violet N Chihota ◽

...

Keyword(s):

South Africa ◽

Verbal Autopsy ◽

Vital Statistics ◽

Classification Systems ◽

Hiv Positive ◽

Hiv Status ◽

Civil Registration ◽

Art Initiation ◽

Better Than ◽

Hiv Negative

IntroductionVerbal autopsy (VA) can be integrated into civil registration and vital statistics systems, but its accuracy in determining HIV-associated causes of death (CoD) is uncertain. We assessed the sensitivity and specificity of VA questions in determining HIV status and antiretroviral therapy (ART) initiation and compared HIV-associated mortality fractions assigned by different VA interpretation methods.MethodsUsing the WHO 2012 instrument with added ART questions, VA was conducted for deaths among adults with known HIV status (356 HIV positive and 103 HIV negative) in South Africa. CoD were assigned using physician-certified VA (PCVA) and computer-coded VA (CCVA) methods and compared with documented HIV status.ResultsThe sensitivity of VA questions in detecting HIV status and ART initiation was 84.3% (95% CI 80 to 88) and 91.0% (95% CI 86 to 95); 283/356 (79.5%) HIV-positive individuals were assigned HIV-associated CoD by PCVA, 166 (46.6%) by InterVA-4.03, 201 (56.5%) by InterVA-5, and 80 (22.5%) and 289 (81.2%) by SmartVA-Analyze V.1.1.1 and V.1.2.1. Agreement between PCVA and older CCVA methods was poor (chance-corrected concordance [CCC] <0; cause-specific mortality fraction [CSMF] accuracy ≤56%) but better between PCVA and updated methods (CCC 0.21–0.75; CSMF accuracy 65%–98%). All methods were specific (specificity 87% to 96%) in assigning HIV-associated CoD.ConclusionAll CCVA interpretation methods underestimated the HIV-associated mortality fraction compared with PCVA; InterVA-5 and SmartVA-Analyze V.1.2.1 performed better than earlier versions. Changes to VA methods and classification systems are needed to track progress towards targets for reducing HIV-associated mortality,

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Relationship between the Cervical Microbiome, HIV Status, and Precancerous Lesions

mBio ◽

10.1128/mbio.02785-18 ◽

2019 ◽

Vol 10 (1) ◽

Cited By ~ 18

Author(s):

Cameron Klein ◽

Daniela Gonzalez ◽

Kandali Samwel ◽

Crispin Kahesa ◽

Julius Mwaiselage ◽

...

Keyword(s):

Hiv Positive ◽

High Grade ◽

Squamous Intraepithelial Lesions ◽

Cervical Lesions ◽

Cervical Cancers ◽

Bacterial Microbiome ◽

Bacterial Richness ◽

Intraepithelial Lesions ◽

Hiv Negative

ABSTRACT Nearly all cervical cancers are causally associated with human papillomavirus (HPV). The burden of HPV-associated dysplasias in sub-Saharan Africa is influenced by HIV. To investigate the role of the bacterial microbiome in cervical dysplasia, cytobrush samples were collected directly from cervical lesions of 144 Tanzanian women. The V4 hypervariable region of the 16S rRNA gene was amplified and deep sequenced. Alpha diversity metrics (Chao1, PD whole tree, and operational taxonomic unit [OTU] estimates) displayed significantly higher bacterial richness in HIV-positive patients (P = 0.01) than in HIV-negative patients. In HIV-positive patients, there was higher bacterial richness in patients with high-grade squamous intraepithelial lesions (HSIL) (P = 0.13) than those without lesions. The most abundant OTUs associated with high-grade squamous intraepithelial lesions were Mycoplasmatales, Pseudomonadales, and Staphylococcus. We suggest that a chronic mycoplasma infection of the cervix may contribute to HPV-dependent dysplasia by sustained inflammatory signals. IMPORTANCE HPV is known to be the causal agent in the majority of cervical cancers. However, the role of the cervical bacterial microbiome in cervical cancer is not clear. To investigate that possibility, we collected cervical cytobrush samples from 144 Tanzanian women and performed deep sequencing of bacterial 16S rRNA genes. We found that HIV-positive patients had greater bacterial richness (P = 0.01) than HIV-negative patients. We also observed that women with high-grade squamous intraepithelial lesions (HSIL) had greater cervical bacterial diversity than women with cytologically normal cervices. Data from our precise sampling of cervical lesions leads us to propose that Mycoplasma contributes to a cervical microbiome status that promotes HPV-related cervical lesions. These results suggest a greater influence of the bacterial microbiota on the outcome of HPV infection than previously thought.

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