Tuberculosis Co-infection Research Articles

The effect of a new coronavirus infection (COVID-19) on clinical and radiological manifestations in patients with comorbidity of respiratory tuberculosis, HIV-infection and opportunistic lung diseases: prospective study design

Aim. To study the features of clinical and radiological manifestations and diagnosis of COVID-19, respiratory tuberculosis and opportunistic lung infections (OIL) coinfection in patients with late stages of HIV-infection with immunodeficiency.
 Materials and methods. The study included 29 patients with COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in the late stages of HIV-infection with immunodeficiency (group 1) and 29 patients similar in all parameters without COVID-19 (group 2). All patients were underwent clinical and laboratory, radiation and bronchological examination, and microbiological, immunological, molecular genetic, cytological and histological examination of diagnostic material of the respiratory tract, cerebrospinal and pleural fluid, blood, urine and feces to identify pathogens of coinfection. Statistical data processing was carried out using the Microsoft Office Excel 2010 program with the calculation of the average in the group and the standard error of the average, confidence interval.
 Results. It has been established that co-infection with COVID-19, respiratory tuberculosis and opportunistic lung infections in patients with late stages of HIV-infection with immunodeficiency is manifested by a pronounced intoxication syndrome, bronchopulmonary manifestations and symptoms of damage to other organs and systems, which is due to the generalization of tuberculosis with extrapulmonary lesions and the development of opportunistic lung infections, as in patients without COVID-19. A computed tomogram of the chest organs with this coinfection visualizes the syndrome of dissemination, the syndrome of adenopathy and the syndrome of pathology of the pulmonary pattern, represented by the compaction of interstitial tissue in the frosted glass type, which is associated with the simultaneous layering of various pathologies, which complicates their differential diagnosis. This determines the similarity of clinical and radiological manifestations of COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in patients with late-stage HIV-infection with immunodeficiency, as in patients without COVID-19. This requires complex microbiological and molecular genetic research methods to identify specific pathogens for the appointment of timely treatment.
 Conclusion. Patients with COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in the late stages of HIV-infection with immunodeficiency pose a high risk of infection in a healthy population, taking into account their social maladaptation and non-adherence to examination and treatment. This requires an active diagnosis of COVID-19 in all patients with respiratory tuberculosis and HIV-infection who are registered in the office of anti-tuberculosis care for HIV-infected in an anti-tuberculosis dispensary, for emergency isolation and treatment.

Treatment of Tuberculosis and the Drug Interactions Associated With HIV-TB Co-Infection Treatment

Tuberculosis (TB) is a communicable disease that is a major source of illness, one of the ten causes of mortality worldwide, and the largest cause of death from a single infectious agent Mycobacterium tuberculosis. HIV infection and TB are a fatal combination, with each speeding up the progression of the other. Barriers to integrated treatment as well as safety concerns on the co-management of HIV- TB co-infection do exist. Many HIV TB co-infected people require concomitant anti-retroviral therapy (ART) and anti-TB medication, which increases survival but also introduces certain management issues, such as drug interactions, combined drug toxicities, and TB immune reconstitution inflammatory syndrome which has been reviewed here. In spite of considerable pharmacokinetic interactions between antiretrovirals and antitubercular drugs, when the pharmacological characteristics of drugs are known and appropriate combination regimens, dosing, and timing of initiation are used, adequate clinical response of both infections can be achieved with an acceptable safety profile. To avoid undesirable drug interactions and side effects in patients, anti TB treatment and ART must be closely monitored. To reduce TB-related mortality among HIV-TB co-infected patients, ART and ATT (Anti Tuberculosis Treatment) outcomes must improve. Clinical practise should prioritise strategies to promote adherence, such as reducing treatment duration, monitoring and treating adverse events, and improving treatment success rates, to reduce the mortality risk of HIV-TB co-infection.

Clinical characteristics and outcome analysis of COVID-19 patients with pulmonary tuberculosis

Coronavirus disease (COVID-19) and tuberculosis (TB) are two respiratory infectious diseases with a high incidence of transmission, mainly via respiratory droplets and both can weaken the immune system and lower the number of CD4+T cells in patients. COVID-19 can occur before, at the same time or after the diagnosis of TB. Patients with pulmonary TB are more likely to have co-infection when they have a history of epidemiological exposure to COVID-19. At present, many cases of nosocomial infection of COVID-19 caused by ineffective prevention and control measures in tuberculosis hospitals have been reported successively at domestic and overseas. Therefore, it is urgent to strengthen the prevention and control of nosocomial infections in tuberculosis hospitals. The superposition of the two diseases can lead to a worsening prognosis, aggravating the patient's condition and making treatment more difficult. In addition, in the context of the new coronavirus epidemic, early recognition of co-infection with new coronavirus should be made when TB patients in chest hospitals present with symptoms such as aggregated fever or progressive disease. At the same time, we should focus on identifying the clinical and imaging manifestations of TB and COVID-19 co-infection. At present, research on COVID-19 complicated with pulmonary TB is scarce, and there are disputes on many aspects. As a country with a high prevalence of tuberculosis, it is of great practical significance to identify the clinical characteristics, outcomes, and treatment of the two infectious diseases in China.

Impact of HIV and multidrug resistant tuberculosis coinfection on CD4+ and CD8+ T cells among patients attending Aminu Kano teaching hospital, Kano, Nigeria

Impact of HIV and multidrug resistant tuberculosis coinfection on CD4+ and CD8+ T cells among patients attending Aminu Kano teaching hospital, Kano, Nigeria

HIV compromises Th17 and Th22 immunity in a humanized mouse model of Tuberculosis and HIV co-infection

Abstract Tuberculosis (TB) kills an estimated 1–2 million people per year and is the leading cause of death in people with HIV (PWH). The CD4+ T helper (Th) populations play significant roles in protective immunity to Mycobacterium tuberculosis (Mtb), and are also important host cells for HIV proliferation and persistence. Emerging evidence in PWH suggests that Th17 and Th22 cells may be preferentially depleted during HIV infection, an outcome that could pose a risk for Mtb containment during co-infection. We employed our humanized mouse model of co-infection to assess pulmonary and peripheral changes in Th17 and Th22 frequency and function due to infection with HIV, Mtb, or both. As determined with multi-plex ELISA, co-infection with HIV suppressed the cytokine response to Mtb including IL-17A, IL-22, IL-6, and IL-1β. Multi-parameter flow cytometric analysis revealed that Mtb and HIV/Mtb infection led to increased Th17+ cells in lung and decreased Th17+ cells in spleen. Following HIV or HIV/Mtb infection, Th22+ cells were significantly decreased in both lung and spleen. Importantly, HIV preferentially infected Th17 cells compared to Th22 and other Th subpopulations. Greater HIV viral load was also observed in the lung, but not spleen, of animals with Mtb/HIV co-infection compared to those with HIV mono-infection. Overall, these results suggest that HIV may compromise Th22 immunity, and exploit Th17+ cells to promote viral pathogenesis, in the setting of Mtb and HIV co-infection. Y.B. Martinez-Martinez is supported by Conacyt-I2T2 in Mexico, Contex, and the James W. McLaughlin Fellowship Fund. Grant support was provided by NIH R01AI147948 award to J. Endsley

CD4 Tcells are rapidly depleted from tuberculosis granulomas following acute SIV co-infection.

HIV/Mycobacterium tuberculosis (Mtb) co-infected individuals have an increased risk of tuberculosis prior to loss of peripheral CD4 Tcells, raising the possibility that HIV co-infection leads to CD4 Tcell depletion in lung tissue before it is evident in blood. Here, we use rhesus macaques to study the early effects of simian immunodeficiency virus (SIV) co-infection on pulmonary granulomas. Two weeks after SIV inoculation of Mtb-infected macaques, Mtb-specific CD4 Tcells are dramatically depleted from granulomas, before CD4 Tcell loss in blood, airways, and lymph nodes, or increases in bacterial loads or radiographic evidence of disease. Spatially, CD4 Tcells are preferentially depleted from the granuloma core and cuff relative to B cell-rich regions. Moreover, live imaging of granuloma explants show that intralesional CD4 Tcell motility is reduced after SIV co-infection. Thus, granuloma CD4 Tcells may be decimated before many co-infected individuals experience the first symptoms of acute HIV infection.

Sensitivity Profile of Fungal Pathogens Responsible for Lower Respiratory Tract Infections in Yaounde

Background: Infectious diseases of the respiratory tract are known as respiratory tract infections (RTIs). An infection of this type usually is further classified as an upper respiratory tract infection (URI or URTI) or a lower respiratory tract infection (LRI or LRTI). LRIs are the leading cause of death among all infectious diseases. The objective of our study was to bring out the sensitivity profile of fungal pathogens responsible for lower respiratory tract infections in Yaounde Methods: We carried out a transverse and descriptive study during a 6 month period (February to June 2021), at the Jamot hospital in Yaounde. Included in this study were patients suffering from a lower respiratory tract infection from whom the medical practitioner had requested a sputum or broncho alveolar liquid analysis A macroscopic, microscopic, fungal culture of the sample was carried out and a germ tube test, fungal sensitivity test as well as specie identification using the ID 32 C gallery was carried out on the positive cultures Statistical analysis was carried out using the R version 3.6.1 software. The mean was calculated with the aid of the Kruskal Wallis rank sum test. Results: 300 patients participated in this study. They had mean age ± standard deviation of 41.59 ± 17.5 years and extremities of 1 and 91years. The male /female ratio was 2:1 Fungal infection was positive in 127 patients (42.33 %), 75 (59%) Candida albicans, 25 (19.68%) Cryptococcus humicola, 10 (7.87%) Candida tropicalis, 6 (4.72%) Candida krusei, 4 (3.14%) Candida famata, 4 (3.14%) Candida sake and 3 (2.36%) Cryptococcus curvatus. As far as antifungigram is concerned, the total drug susceptibility was Nystatine (98.47%), Amphotericine B (86.91%), Miconazole (55.42%), Econazole (52.61%), Ketoconazole (52.57%) and Fluconazole (14.42%).The prevalence of fungal pathogens was 42.33%. Of the 300 patients, 71 had tuberculosis, 24 were HIV positive and 6 were diabetic we had 5 patients with HIV, tuberculosis and fungal co-infection, 16 with HIV and fungal co-infection and 6 with HIV and tuberculosis co-infection. Conclusion: This study shows a relative high prevalence (42.33%) of the colonization of the respiratory tract by fungal pathogens. The fungal pathogens responsible for lower respiratory tract infections are Candida albicans, Candida tropicalis, Candida krusei, Candida famata, Candida sake, Cryptococcus humicola and Cryptococcus curvatus. The drug of choice is Nystatine and Fluconazole presents a very limited activity. Additional studies should be carried out in other towns in order to better document this issue in Cameroon.

Optimal control of TB transmission based on an age structured HIV-TB co-infection model

The World Health Organization’s 2021 global tuberculosis report points out that people living with human immunodeficiency virus are more likely than others to become sick with tuberculosis. Therefore, it is necessary to consider the factor of human immunodeficiency virus infection when studying how to control the tuberculosis epidemic. In this paper, we establish an age structured human immunodeficiency virus and tuberculosis co-infection model and prove well-posedness of the model. Then we study the least cost-deviation problem. In this problem, detection and treatment of latent tuberculosis cases and public education campaigns are use as the control variables. Through rigorous theoretical derivation and detailed mathematical calculation, we obtain the necessary condition of optimal control. We also perform numerical simulation based on the forward-backward sweep method. Finally, combining the theoretical analysis with numerical simulation of the model, we present optimal strategies that may help China achieve the End Tuberculosis Strategy of the World Health Organization as much as possible (the new tuberculosis cases reduce by 90% by 2035 compared to 2015). In addition, in the process of numerical simulation, we also study the effect of available funds on control effectiveness and find that the control effect is better in the case of sufficiency of available funds, which shows that available funds are crucial to tuberculosis control.

Tuberculosis challenges: Resistance, co-infection, diagnosis, and treatment.

Early diagnosis of tuberculosis (TB), followed by effective treatment, is the cornerstone of global TB control efforts. An estimated 3 million cases of TB remain undetected each year. Early detection and effective management of TB can prevent severe disease and reduce mortality and transmission. Intrinsic and acquired drug resistance of Mycobacterium tuberculosis (MTB) severely restricted the anti-TB therapeutic options, and public health policies are required to preserve the new medications to treat TB. In addition, TB and HIV frequently accelerate the progression of each other, and one disease can enhance the other effect. Overall, TB-HIV co-infections show an adverse bidirectional interaction. For HIV-infected patients, the risk of developing TB disease is approximately 22 times higher than for persons with a protective immune response. Analysis of the current TB challenges is critical to meet the goals of the end TB strategy and can go a long way in eradicating the disease. It provides opportunities for global TB control and demonstrates the efforts required to accelerate eliminating TB. This review will discuss the main challenges of the TB era, including resistance, co-infection, diagnosis, and treatment.

Health-care provision for displaced populations arriving from Ukraine

Health-care provision for displaced populations arriving from Ukraine

Tuberculosis Co-Infection Is Common in Patients Requiring Hospitalization for COVID-19 in Belarus: Mixed-Methods Study.

A significant drop in tuberculosis (TB) case-finding has been widely reported during the period of the COVID-19 pandemic. To address a decrease in TB notification, Belarus introduced laboratory TB testing in patients with the laboratory-confirmed coronavirus disease 2019 (COVID-19). We conducted a secondary analysis of health records among 844 patients with laboratory-confirmed COVID-19 diagnosis who were admitted to repurposed departments at TB hospitals and who were tested by Xpert MTB/RIF (Cepheid Inc., Sunnyvale, CA, USA) in five Belarus regions between April and October 2021. Quantitative analysis followed by 13 individual interviews with health managers, physicians, and nurses participating in the intervention. Most patients were male (64%) and mean age was 43.5 ± 16 years. One in twenty (n = 47, 5.6%) patients were co-infected with active pulmonary TB, and over one-third of them (n = 18) had rifampicin resistance. In-hospital mortality was comparable in patients with and without TB co-infection (2.1% and 2.3% respectively, p > 0.99). Laboratory TB testing among patients with COVID-19 at repurposed departments of TB hospitals is feasible in Belarus and may improve TB case-finding.

Trends of notification rates and treatment outcomes of tuberculosis cases with and without HIV co-infection in eight rural districts of Uganda (2015 \u2013 2019)

BackgroundThe End TB Strategy aims to reduce new tuberculosis (TB) cases by 90% and TB-related deaths by 95% between 2015 – 2035. We determined the trend of case notification rates (CNRs) and treatment outcomes of TB cases with and without HIV co-infection in rural Uganda to provide an interim evaluation of progress towards this global target in rural settings.MethodsWe extracted retrospective programmatic data on notified TB cases and treatment outcomes from 2015 – 2019 for eight districts in rural Uganda from the District Health Information System 2. We estimated CNRs as the number of TB cases per 100,000 population. Treatment success rate (TSR) was calculated as the sum of TB cure and treatment completion for each year. Trends were estimated using the Mann–Kendall test.ResultsA total of 11,804 TB cases, of which 5,811 (49.2%) were HIV co-infected, were notified. The overall TB CNR increased by 3.7-fold from 37.7 to 141.3 cases per 100,000 population in 2015 and 2019 respectively. The increment was observed among people with HIV (from 204.7 to 730.2 per 100,000, p = 0.028) and HIV-uninfected individuals (from 19.9 to 78.7 per 100,000, p = 0.028).There was a decline in the TSR among HIV-negative TB cases from 82.1% in 2015 to 63.9% in 2019 (p = 0.086). Conversely, there was an increase in the TSR among HIV co-infected TB cases (from 69.9% to 81.9%, p = 0.807).ConclusionThe CNR increased among people with and without HIV while the TSR reduced among HIV-negative TB cases. There is need to refocus programs to address barriers to treatment success among HIV-negative TB cases.

THE ASSOCIATION BETWEEN TUBERCULOSIS RISK FACTORS AND VITAMIN D SERUM LEVEL ON TUBERCULOSIS PATIENS

Background: Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis which attacks various organs. Tuberculosis has risk factors for age, sex, nutritional status, HIV infection, history of diabetes, corticosteroid use, and history of primary TB. Prolonged tuberculosis causes a decrease in vitamin D levels in blood serum.Objective: This study aims to look at the association of risk factors to serum vitamin D levels in TB sufferersMethod: Research conducted is analytic with cross-sectional design. The sample of the study were 30 patients with TB in Haji Adam Malik General Hospital, Teladan and Amplas primary health center Medan who had met the inclusion and exclusion criteria. Results: Pearson correlation test showed there was an inverse correlation between BMI and vitamin D levels (p = 0.007; r = -0.482) and there was no significant relationship between age and vitamin D levels. Fisher exact test found no association between vitamin D levels on corticosteroid use (p = 1,000), history of diabetes (p = 0.469), HIV coinfection, and primary TB (p = 1,000). Conclusion: In conclusion, there is an inverse correlation between the BMI value and vitamin D levels. No association was found between vitamin D levels and age, corticosteroid use, and history of diabetes.

SARS-COV-2 AND TUBERCULOSIS CO-INFECTION: AUDIT ON PATIENT EXPERIENCE ON TREATMENT SERVICES AT THE NATIONAL HOSPITAL FOR RESPIRATORY DISEASES-WELISARA, SRI LANKA

Background:Patients who are well informed and motivated are more likely to utilize health services, thus, it improves adherence to medication. Hence, this audit aimed to improve the patient experience on treatment services at the National Hospital for Respiratory Diseases (NHRD), Welisara, Sri Lanka. Methods:Patients admitted from 15th August 2021 to 25th February 2022 to the NHRD and diagnosed with COVID-19 and tuberculosis (TB) co-infection were included. Twnety-two (22) process indicators were used and data were collected using a pretested self-administered questionnaire.Sixty-percent of thepatients had a good experience for each service received was the standard. Data were presented as frequency distributions and mean with their standard deviation (SD). Informed written consent was obtained prior to the data collection. Results: Out of 60 patients who were diagnosed with SARS-CoV-2 and TB co-infection, 59 were responded (response rate was 98.3%). A majority were males (n=47, 79.7%) and belonged to 41 to 60 age category (n=29, 49.2%). Ten indicators did not meet the standard. The highest experience was shown in perceived waiting time (mean 86.8, SD ± 8.8) and the lowest experience was shown in perceived time spent with the health care provider (mean 57.9, SD ± 11.8). More than half (n=31, 52.5%) of the patients reported overall good experiences on treatment services. However, age and gender did not show any significant relationship with the good experience of treatment services received (p>0.05). Conclusion: This audit shows the marginally good experience of treatment services received, but highlight areas such as time to discuss with the doctor, instructions on treatment given by the doctor and information given on available services on continuation of TB treatment are needed much improvement even in the pandemic situation.

Identifying predictors of progression to AIDS and mortality post-HIV infection using parametric multistate model


 OBJECTIVES: The human immunodeficiency virus (HIV) has already remained as a major public health problem all over the world. This study aimed to identify the prognostic factors influencing the disease progression in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Iran, using parametric multi-state models to take into account the intermediate event in the analysis. 
 METHOD(S): The data of the present retrospective cohort study was extracted in Tehran from April 2004 to March 2014. The number of 2473 HIV-infected patients in Behavioral Diseases Counseling Centers was enrolled. The outcomes of interest were the transition times from HIV diagnosis to AIDS and AIDS to death. The effect of several prognostic factors on both transitions was investigated.
 RESULTS: Parametric models indicated that AIDS progression was significantly associated with an increase in age (P = 0.017), low education (P = 0.026), and a decreased CD4 cell count (P = 0.001). Furthermore, the AIDS-related death was significantly associated with male sex (P = 0.010), tuberculosis coinfection (P = 0.001), antiretroviral therapy (P = 0.001) and a decreased CD4 cell count (P = 0.035).
 CONCLUSION: The results of this study indicated that CD4 cell count was one of the most important prognostic factors that affected and accelerated both HIV→AIDS and AIDS→DEATH transitions and antiretroviral treatment was found to be an effective measure in decelerating survival of patients with AIDS to death state. The usual Cox Model is not able to identify some of these prognostic factors. 

Mathematical Modeling and Analysis of TB and COVID-19 Coinfection

Tuberculosis (TB) and coronavirus (COVID-19) are both infectious diseases that globally continue affecting millions of people every year. They have similar symptoms such as cough, fever, and difficulty breathing but differ in incubation periods. This paper introduces a mathematical model for the transmission dynamics of TB and COVID-19 coinfection using a system of nonlinear ordinary differential equations. The well-posedness of the proposed coinfection model is then analytically studied by showing properties such as the existence, boundedness, and positivity of the solutions. The stability analysis of the equilibrium points of submodels is also discussed separately after computing the basic reproduction numbers. In each case, the disease-free equilibrium points of the submodels are proved to be both locally and globally stable if the reproduction numbers are less than unity. Besides, the coinfection disease-free equilibrium point is proved to be conditionally stable. The sensitivity and bifurcation analysis are also studied. Different simulation cases were performed to supplement the analytical results.

Coexistence of tuberculosis and COVID-19 pneumonia: A presentation of 16 patients from Turkey with their clinical features.

Coronavirus disease 2019 (COVID-19) and tuberculosis are serious and mortal diseases worldwide. There are few studies about the association between tuberculosis and COVID-19 pneumonia. We aimed to describe the characteristics of tuberculosis and COVID-19 co-infection cases in light of the literature. Tuberculosis patients who applied to the tuberculosis outpatient clinic between September 1-September 30, 2020, and patients hospitalized in the COVID-19 service between June 1- September 30, 2020, were retrospectively screened. Patients with tuberculosis and COVID-19 co-infection were recorded. Clinical, radiological, laboratory data, and treatments were recorded and analyzed. For the diagnosis of tuberculosis, sputum acid-resistant bacillus (ARB) smear or culture positivity or pathological diagnosis were used. For the diagnosis of COVID-19, positive real-time reverse transcription-polymerase chain reaction and/or typical radiological findings were sought. Seven hundred and fifty-one patients' data at the tuberculosis outpatient clinic, 229 patients' data at the COVID-19 clinic were screened. Sixteen patients meet the criteria. COVID-19 infection rate in tuberculosis patients was 2.1%. Sixty-nine percent of the patients had received COVID-19 disease during diagnosis or initial tuberculosis treatment phase. There were no drugdrug interactions between anti-tuberculosis drugs and COVID-19 treatment. During the COVID-19 treatment, one patient (6%) died, 15 (94%) patients completed the treatment. : In our study, no effect of the coexistence of TB and COVID-19 on morbidity or mortality was observed. Although the number of patients is small, it can be said that patients with early TB disease and with widespread involvement may be riskier for COVID-19 infection. Frequent hospital visits by TB patients may be a risk for COVID-19. It may be beneficial to carry out the diagnosis and treatment of tuberculosis patients by tuberculosis dispensaries as in our country or authorized units to reduce the risk of hospital admissions and COVID-19 transmission.

Predominance of Other Pathogenic Bacteria among Presumptive Tuberculosis Cases Attending Tuberculosis Clinics in Mwanza, Tanzania: A Cross-Sectional Laboratory-Based Study.

This study was designed to determine the prevalence and co-infection of Mycobacterium tuberculosis and other pathogenic bacteria among presumptive cases of tuberculosis (TB) at selected hospitals in Mwanza, Tanzania. GeneXpert and conventional bacteriological culture and sensitivity were used for the detection of TB and other pathogenic bacteria, respectively. STATA version 13.0 was used for data analysis. The median (IQR) age of participants was 33 (19–51) years with males forming more than half (i.e., 59% (158/264)) of the participants. Microscopically, 29.5% (78/264) of the patients had polymorphonuclear leucocytes in the sputum samples. Approximately 7.2% (19/264), 16.3% (43/264), and 1.1% (3/264) of participants had TB, other pathogenic bacteria, and co-infections, respectively. One sample had growth of two other bacteria, resulting in a total of 44 isolated bacteria with the predominance of Gram-negative bacteria at 75.0% (33/44). The predominant species isolated was the Klebsiella pneumoniae complex at 52.3% (23/44). Overall, 27.3% (9/33) of GNB were resistant to third-generation cephalosporins, while Gram-positive bacteria were more resistant to erythromycin at 63.6% (7/11). Good quality sputa had a significantly higher yield of pathogenic bacteria than poor quality sputa (37.2% vs. 7.5%, p < 0.001). Presumptive TB cases were predominantly infected with other pathogenic bacteria than M. tuberculosis. Therefore, other pathogenic bacteria should be considered when attending presumptive TB cases to ensure favorable treatment outcomes.

Coinfection of Tuberculosis and HIV in Nigeria: A Systematic Review and Meta-analysis.

Tuberculosis (TB) and HIV/AIDS are major public health issues globally. The burden of these diseases is particularly significant in Nigeria due to the high TB and HIV/AIDS prevalence. This meta-analysis for the 1st time addressed the TB/HIV coinfection prevalence in Nigeria at the regional level. A total of 58 relevant publications comprising 80 studies (n = 44,508) were obtained from PUBMED, ScienceDirect, African Journals Online, and Cochrane Library databases using carefully constructed keywords combinations. The PRISMA guideline was followed for this meta-analysis. Two independent reviewers conducted the publication screening, data extraction and methodological quality appraisal with a third reviewer serving as arbitrator. The pooled estimates were calculated using the random effects model. Heterogeneity was assessed using Cochran's Q and I 2 statistic. Univariate and multivariate meta-regressions were done to predict sources of between-study heterogeneity. Overall, the pooled prevalence of TB/HIV coinfection was 25.8%. The highest coinfection prevalence of 34.3% was recorded among the North Central States of Nigeria, while the least prevalence of 19.3% was recorded among the Southeastern states of Nigeria. There was a paucity of published articles from the Northeastern states of Nigeria. There was a significant heterogeneity between studies (I2 > 90%, p < 0.001), but meta-regression analysis only explained < 10% of it. This study has shown that the prevalence of TB/HIV coinfection remains significantly high in Nigeria. Constant surveillance should be rigorously implemented with special attention given to the Northeast due to the ongoing crises that are compounding the problem.

Optimising tuberculosis care for refugees affected by armed conflicts

Globally, tuberculosis remains a leading cause of death from an infectious disease. 1 WHOGlobal tuberculosis report 2021. World Health Organization, Geneva2021https://www.who.int/publications/i/item/9789240037021Date accessed: March 9, 2022 Google Scholar 2022's theme for World TB Day, on March 24, is “Invest to End TB. Save Lives”. Tuberculosis control requires a pragmatic, tailored, multipronged approach to diagnose and treat all people with tuberculosis disease (drug-susceptible, drug-resistant, multidrug-resistant, and extensively drug-resistant tuberculosis) and latent tuberculosis infection, to prevent transmission, and to mitigate the risk of drug resistance. The COVID-19 pandemic has disrupted health services and derailed already overburdened tuberculosis control programmes worldwide, including in eastern Europe, substantially setting back progress 1 WHOGlobal tuberculosis report 2021. World Health Organization, Geneva2021https://www.who.int/publications/i/item/9789240037021Date accessed: March 9, 2022 Google Scholar towards achieving the UN Sustainable Development Goal (SDG) and End TB targets. 2 Migliori GB Thong PM Alffenaar JW et al. Gauging the impact of the COVID-19 pandemic on tuberculosis services: a global study. Eur Respir J. 2021; 582101786 Crossref PubMed Scopus (41) Google Scholar The invasion of Ukraine by Russia, and the ongoing armed conflict, is having hugely damaging effects on health services, health infrastructure, and personnel, and further diminishes hope of achieving End TB targets for eastern Europe—now a seemingly insurmountable task. Although incidence rates of tuberculosis in Ukraine have gradually decreased over the past decade, Ukraine features in the WHO list of 20 countries with the highest estimated number of people with incident drug-resistant tuberculosis and it has one of the highest rates of HIV–tuberculosis co-infection and latent multidrug-resistant tuberculosis infection in Europe. 1 WHOGlobal tuberculosis report 2021. World Health Organization, Geneva2021https://www.who.int/publications/i/item/9789240037021Date accessed: March 9, 2022 Google Scholar Drug-resistant tuberculosis is difficult to diagnose, expensive to treat, requires long-term treatment, has high mortality, and requires careful follow-up to monitor adverse drug side-effects and ensure a cure.