Tuberculosis Co-infection Research Articles

Application of random survival forest for competing risks in prediction of cumulative incidence function for progression to AIDS

Objective: There has remained a need to better understanding of prognostic factors that affect the survival or risk in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), particularly in developing countries. The aim of the present study aimed to identify the prognostic factors influencing AIDS progression in HIV positive patients in Hamadan province of Iran, using random survival forest in the presence of competing risks (death from causes not related to AIDS). This method considers all interactions between variables and their nonlinear effects.
 Method(s): A data set of 585 HIV-infected patients extracted from 1997 to 2011 was utilized. The effect of several prognostic factors on cumulative incidence function (probability) of AIDS progression and death were investigated.
 Result: The used model indicated that using antiretroviral therapy tuberculosis co-infection are two top most important variables in predicting cumulative incidence function for AIDS progression in the presence of competing risks, respectively. The patients with tuberculosis had much higher predicted cumulative incidence probability. Predicted cumulative incidence probability of AIDS progression was also higher for mother to child mode of HIV transmission. Moreover, transmission type and gender were two top most important variables for the competing event. Men and those patients with IDUS transmission mode had higher predicted risk compared to others.
 Conclusion: Considering nonlinear effects and interaction between variables, confection with tuberculosis was the most important variable in prediction of cumulative incidence probability of AIDS progression.

Neutrophils and lymphocytes in relation to MMP-8 and MMP-9 levels in pulmonary tuberculosis and HIV co-infection

BackgroundMatrix metalloproteinase (MMP) activity has an important role in lung cavitary formation occurred in pulmonary tuberculosis (TB). Low number and viability of CD4 + T-lymphocytes in patients with TB/HIV co-infection leads to impaired neutrophils production, causing further impaired MMPs production. ObjectiveTo explore association of neutrophils and lymphocytes count to MMP-8 and MMP-9 among pulmonary TB patients with cavitary lesion and HIV co-infection. MethodsWe conducted a cross-sectional study using a purposive sampling technique among patients with non-cavitary TB (n = 50), cavitary TB (n = 50) and TB/HIV (n = 27). Complete blood count was examined, including neutrophils and lymphocytes count. MMP-8 and MMP-9 were measured from plasma samples using ELISA method. Statistical analysis was conducted to determine the relation between neutrophils, lymphocytes and MMPs. ResultMMP-8 and MMP-9 were positively correlated with neutrophils, but not to lymphocytes in all groups. Neutrophils, lymphocytes, and MMP-9 were significantly lower in TB/HIV co-infection, whereas MMP-8 was higher compared to new pulmonary TB. Interestingly, in cavitary TB, low lymphocytes were significantly correlated with higher level of MMP-8 and larger extent of lung affected. ConclusionMMP-8 and MMP-9 are associated with neutrophil count, suggesting that neutrophils contribute significantly to their secretion. MMP-8 is significantly higher in TB/HIV co-infection and extent of lung damage in cavitary TB with lower lymphocyte count. This study suggests that lower lymphocyte level is related to higher neutrophil orchestrated inflammation, leading to tissue destruction.

The impact of tuberculosis co-infection on virological failure among adults living with HIV in Ethiopia: A systematic review and meta-analysis

IntroductionTuberculosis (TB) is the most common serious opportunistic infection among people with Human Immunodeficiency Virus (HIV) infection and are considered as the double burden diseases of the world. TB is the leading cause of death among people living with HIV, accounting one in three HIV related deaths. Although TB is responsible for high burden of virological unsuppressed in Ethiopia, there is no national level evidence. Therefore, this systematic review and meta-analysis was aimed at estimating the pooled burden of virological unsuppressed among adults with both HIV-TB and impact of TB on virological failure in Ethiopia. MethodsThe finding of this meta-analysis was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklists. Major data bases PubMed, Scopus, Cochrane Library, Science Direct and Google scholar were searched to access articles. Cochran’s Q statistic quantified with inverse variance was computed to check heterogeneity. Funnel plot visualization and Egger’s test were fitted to assess publication bias across included studies. Random effects model meta-analysis using STATA version-15 statistical software was used to estimate the pooled effect with respective 95% confidence intervals. ResultsA total of 15 primary studies reporting on impact of tuberculosis on virological unsuppressed among adults living with HIV in Ethiopia were eligible for this meta-analysis. Accordingly, the pooled prevalence of virological unsuppressed among adults with both HIV-TB in Ethiopia was 39.09% (95% CI: 29.04, 49.15). In addition, the odds of virological unsuppressed among adults with both HIV-TB was 2.46 times higher when compared with adults living with HIV infection alone (OR = 2.46, 95% CI: 1.74, 3.46). ConclusionThe present systematic review and meta-analysis evidenced that the pooled prevalence of virological unsuppressed among adults with both HIV-TB was much higher than virological unsuppressed among adults living with HIV alone. Moreover, the odds of virological failure among adults with both HIV-TB was significantly higher when compared with among only HIV infection in Ethiopia. Therefore, strengthening TB prevention interventions, early identification and managing the case and prioritizing viral load monitoring and adherence support among adults living with HIV are recommended.

World Tuberculosis Day 2022: aligning COVID-19 and tuberculosis innovations to save lives and to end tuberculosis

World Tuberculosis Day 2022: aligning COVID-19 and tuberculosis innovations to save lives and to end tuberculosis

Increased Mortality in HIV Infected Individuals with Tuberculosis: A Retrospective Cohort Study, Addis Ababa, Ethiopia.

BackgroundTuberculosis is one of the commonest coinfections and leading causes of death among people living with HIV in resource-limited countries. There is limited evidence on the short- and long-term mortality rate in people receiving antiretroviral therapy and coinfected by tuberculosis in sub-Saharan Africa, where the burden of coinfection is highest.PurposeThis study aimed to compare mortality among HIV positives with and without tuberculosis coinfection receiving antiretroviral therapy in Addis Ababa, Ethiopia.MethodsHIV positives’ medical records were reviewed between 2011 to 2018 and identified 7038 HIV-positive adults enrolled for antiretroviral therapy in Addis Ababa. The outcome of interest for this study was death. A parametric Gompertz regression model was applied to compare mortality between HIV with tuberculosis coinfection versus HIV without tuberculosis.ResultsOverall, 1123 (15.96%, 95% CI: 15.11–16.83%) individuals with HIV had tuberculosis coinfection at antiretroviral therapy enrollment. After adjusting for age, sex, education, marital status, cotrimoxazole therapy, body mass index, baseline CD4 cell count, and year in ART enrollment, HIV positives with tuberculosis coinfection had more than twice a higher overall mortality risk than HIV positives without tuberculosis coinfection (AHR: 2.53; 95% CI 1.63–3.91, p < 0.001).ConclusionThis large retrospective cohort study reveals significantly higher mortality in HIV and tuberculosis coinfected group. This suggests the need for enhanced utility of integrated HIV and tuberculosis health services in sub-Saharan Africa where tuberculosis prevalence is highest.

HIV and TB co-infection: A double ethical challenge in South African public hospitals

Managing patients with human immunodeficiency virus (HIV) and Tuberculosis (TB) or those with co-infections of HIV and TB (HIV/TB) requires close interactions between patients and health care professionals (HCPs). However, ethical principles contradicting ethical practice pose challenges for these patients. This survey based cross-sectional study used a questionnaire with three sections for HCPs, consisting of nurses, physiotherapists , occupational, speech and audiology therapists from three public hospitals, in South Africa. This study found 92% HCPs experienced ethical challenges with HIV/TB patients. Limited hospital resources, non-adherence to ethical principles, stigma, discrimination and fear of cross infection were contributing negative perceptions towards these patients . Challenges experienced with HIV/TB patients requires concerted and sustained interventions to overcome in clinical practice. These are, but not limited to, priority to improve public hospital resources, implement guidelines, policies and education to encourage and enhance ethical principles and practice to ameliorate ethical challenges with HIV/TB patients.

Keynote Message - Dr. Anthony S. Fauci

Warm greetings to you all. My name is Dr. Tony Fauci, and I am the Director of the National Institute of Allergy and Infectious (NIAID) at the U.S. National Institutes of Health and Chief Medical Adviser to President Joe Biden. I sincerely appreciate being asked to help open the National Academy of Science and Technology, Philippines’ 43rd Annual Scientific Meeting with its focus on learning from the past to inform the future. Among the most important lessons we have learned from the COVID-19 pandemic is that sustained biomedical research is essential to global well-being, as manifested by the successful development of highly effective vaccines against SARS-CoV-2. We also have seen that an effective response to emerging infectious diseases requires international scientific cooperation. Keeping in mind the theme of this meeting, I would like to briefly highlight the value and importance of research cooperation between the United States and the Philippines while expressing my hope that this cooperation will continue and thrive in the coming years. The institute I lead, NIAID, has supported US and Filipino scientists working together for more than 30 years. As we now fight SARS-CoV-2, HIV, and other viral diseases together, our efforts continue to grow when scientific importance and public health value. Over the years, much productive NIAID supported collaborative research in the Philippines has focused on HIV and tuberculosis co-infections. Talented Filipino scientists from your outstanding institutions have participated in multiple AIDS clinical research networks that have advanced the global understanding of HIV prevention, treatment, and care particularly while addressing TB as a comorbidity in resource challenge settings. Participation of the Philippines in these multi-country networks has helped ensure that your scientists are among the core of key contributors advancing biomedical discoveries that have made AIDS a preventable chronic disease rather than an acute one with a high degree of mortality. In addition to participation in HIV/AIDS research, Filipino scientists have helped lead the way in studies of tuberculosis particularly multidrug-resistant TB (MDR TB). The work in the Regional Prospective Observational Research in Tuberculosis (RePORT) network has been especially important and promising. With continuing support from the Department of Science and Technology (DOST), the Philippines is sure to make significant contributions to the global fight against TB. Philippine institutions also have played an important in other infectious diseases research. For example, Filipino scientists continue to lead research on dengue (another flaviviruses), malaria, and schistosomiasis building on prior NIAID support for Filipino studies on these pathogens. For many years the Research Institute for Tropical Medicine (RITM) received NIAID funding as a tropical medicine research center of excellence. Hopefully, this institution and others will continue to receive Philippine government support so that they will remain competitive for both funding and talent. Given this track record, I also can foresee great value in the Philippines expanding its scientific leadership role in the Asia-Pacific region. In this regard, we are pleased to partner with the Department of Science and Technology through the e-ASIA Joint Research Program (e-ASIA JRP). In the future, this program–which supports collaborative research involving US and Filipino scientists–has the potential of adding real value to our overall research efforts, as long as it is adequately supported by all the participating agencies. In closing, I want to emphasize the importance of sustained local support for scientists and scientific institutions in the Philippines and elsewhere. This support is necessary foundation to attract funding from outside the country. It is also an essential element for economic vitality and growth. In addition, as we have seen with COVID-19, science–particularly biomedical research–is fundamentally important to pandemic preparedness and effective outbreak responses that save lives and stabilize societies. Fortunately, the Philippines has long recognized the value of science. Just four (4) months ago, we saw this again when NIAID and DOST jointly sponsored a special COVID-19 workshop focused on research findings and scientists in this region. With the success of that workshop, we look forward to convening the 2022 emerging infectious diseases of the Pacific Rim Conference which DOST has offered to co-host along with NIH and Japan’s AMED. Thank you again for a long-standing scientific partnership and for the continuing commitment of the Philippines to the global research enterprise. Through decades of collaboration, we have learned from each other and share the tradition of excellence in science and technology particularly in biomedical research. I am confident that our future collaborations will continue to contribute to scientific discovery through basic and clinical research and the training of the talented new scientists. I wish you every success with your 43rd Annual Scientific Conference and with the implementation of its results.

Evaluation of Diagnostic Microbiology Capacity and Barriers in Testing for HIV and TB at Peripheral Hospital-Based Laboratories in Oyo-State, Nigeria.

ABSTRACTThe prevalence of tuberculosis (TB) and human immunodeficiency virus (HIV) coinfection in Nigeria is currently around 19.1%. This indicates that the two diseases are still a burden on the nation”s health. The aim of this study was to evaluate the diagnostic microbiology capacity and the barriers in performing assay for TB and HIV at peripheral district-level hospital-based laboratories in Oyo State, Nigeria. Diagnostic microbiology capacity was estimated using a scale of 100-point where scores ≤ 49% were categorized as low, 50–79% fair and ≥80% good. Barriers to diagnosis were summarized in proportions. The diagnostic microbiology capacity revealed that 6 (35.3%) and 11 (64.7%) of the laboratories had “fair” and “low” capacity, respectively, to detect TB in cerebrospinal fluid/sputum. In testing for HIV, 3 (17.6%) of the laboratories had “fair capacity” and 14 (82.4%) had “low capacity” to detect CD4 count and HIV antibodies in blood serum. The major diagnostic barriers in almost all (94.1%) the laboratories were lack of culture supplies and nonavailability of reagents/testing kits. There was no diagnostic microbiology service with good capacity to facilitate case detection of HIV and TB at the peripheral hospitals. Hence there is a need to improve the supply of reagents, culture stock and testing kits. This will facilitate the detection of TB and HIV cases in peripheral communities.IMPORTANCE This study provided a snapshot knowledge of testing capabilities and commodity availability at state laboratories. The findings should inform the action of stakeholders to improve diagnostic microbiology capacity, consequently enhancing diagnostic measures in detecting human immunodeficiency virus and Mycobacterium tuberculosis.

Lymphocutaneous Nocardiosis in a Patient With Human Immunodeficiency/Tuberculosis Coinfection

Nocardia spp. are Gram-positive bacteria, which are acid-fast as well. Nocardiosis is characterized by abscess formation anywhere in the body, especially in the lungs, brain, and skin. The disease manifests as pulmonary disease, brain abscess, or disseminated lesions in immunocompromised individuals. However, skin involvement in the form of lymphocutaneous abscess is found in immunocompetent individuals. Nocardia spp. appear as thin, branched filaments in fine needle aspirate under the microscope. Diagnosis of the nocardiosis is done by fine needle aspiration cytology (FNAC) and identification through matrix-assisted laser desorption/ionization-time of flight mass spectrometry from aspirated materials. Our case is lymphocutaneous nocardiosis in a patient having human immunodeficiency (HIV)/tuberculosis coinfection.

Tuberculosis and Covid-19 Co-infection

Tuberculosis and Covid-19 Co-infection

Single-cell transcriptomic landscape identifies the expansion of peripheral blood monocytes as an indicator of HIV-1-TB co-infection.

Certain circulating cell subsets are involved in immune dysregulation in human immunodeficiency virus type 1 (HIV-1) and tuberculosis (TB) co-infection; however, the characteristics and role of these subclusters are unknown. Peripheral blood mononuclear cells (PBMCs) of patients with HIV-1 infection alone (HIV-pre) and those with HIV-1-TB co-infection without anti-TB treatment (HIV-pre & TB-pre) and with anti-TB treatment for 2 weeks (HIV-pre & TB-pos) were subjected to single-cell RNA sequencing (scRNA-seq) to characterize the transcriptome of different immune cell subclusters. We obtained > 60,000cells and identified 32cell subclusters based on gene expression. The proportion of immune-cell subclusters was altered in HIV-1-TB co-infected individuals compared with that in HIV-pre-group, indicating immune dysregulation corresponding to different disease states. The proportion of an inflammatory CD14+CD16+ monocyte subset was higher in the HIV-pre & TB-pre group than in the HIV-pre group; this was validated in an additional cohort (n=80) via a blood cell differential test, which also demonstrated a good discriminative performance (area under the curve, 0.8046). These findings depicted the atlas of immune PBMC subclusters in HIV-1-TB co-infection and demonstrate that monocyte subsets in peripheral blood might serve as a discriminating biomarker for diagnosis of HIV-1-TB co-infection.

Immunosuppressive Features of the Microenvironment in Lymph Nodes Granulomas from Tuberculosis and HIV–Co-Infected Patients

Tuberculosis (TB) and HIV co-infection claims many lives every year. This study assessed immune responses in Mycobacterium tuberculosis–infected lymph node tissues from HIV-negative and HIV-positive patients compared with the peripheral circulation with a focus on myeloid cells and the cell-signaling enzymes, inducible nitric oxide synthase, and arginase (Arg)-1. Methods included immunohistochemistry or confocal microscopy and computerized image analyses, quantitative real-time PCR, multiplex Luminex, and flow cytometry. These findings indicate enhanced chronic inflammation and immune activation in TB/HIV co-infection but also enhanced immunosuppressive responses. Poorly formed necrotic TB granulomas with a high expression of M. tuberculosis antigens were elevated in TB/HIV–co-infected lymph nodes, and inducible nitric oxide synthase and Arg-1 expression was significantly higher in TB/HIV–co-infected compared with HIV-negative TB or control tissues. High Arg-1 expression was found in myeloid cells with a phenotype characteristic of myeloid-derived suppressor cells (MDCS) that were particularly abundant in TB/HIV–co-infected tissues. Accordingly, Lin−/HLA-DRlow/int/CD33+/CD11b+/CD15+ granulocytic myeloid-derived suppressor cells were significantly elevated in blood samples from TB/HIV–co-infected patients. CD15+ myeloid-derived suppressor cells correlated with plasma HIV viral load and M. tuberculosis antigen load in tissue but were inversely associated with peripheral CD4 T-cells counts. Enhanced chronic inflammation driven by M. tuberculosis and HIV co-infection may promote Arg-1–expressing MDSCs at the site of infection thereby advancing TB disease progression.

Tuberculosis and Covid-19 Co-Infection

Tuberculosis (TB) is still common in many parts of the world, and requires monitoring, clinical assessment, testing, contact tracing, confirmation of diagnosis, and treatment regimens that are either supervised or unsupervised for effective eradication. We examine the problems posed by the COVID-19 pandemic to tuberculosis management and the current policies in place to address them. There are some similarities between tuberculosis and respiratory viral infectious illnesses, such as COVID-19. They mostly infect susceptible populations by droplet transfer or other infectious source transmission pathways. Acute respiratory infectious illnesses affect patients with tuberculosis and as Tuberculosis is one of the top ten causes of death worldwide patients with active tuberculosis more likely to have covid -19 infection, in this review paper we examine when two infection clash.

Talaromyces marneffei and Mycobacterium tuberculosis co-infection in a patient with high titer anti-interferon-\u03b3 autoantibodies: a case report

BackgroundHigh-titer anti-interferon (IFN)-γ autoantibodies are strongly associated with intracellular pathogens such as nontuberculous mycobacteria and Talaromyces marneffei, but they are not as commonly associated with Talaromyces marneffei co-infected with Mycobacterium tuberculosis.Case presentationHerein, we report a case of an HIV-negative Chinese man with a severe, disseminated co-infection of Talaromyces marneffei and Mycobacterium tuberculosis, who had a high-titer of anti IFN-γ autoantibodies and a CFI heterozygous nonsense gene mutation. The patient rapidly developed sepsis and died. Through by flow cytometry for CD4+ T cells’ intracellular phosphorylated STAT-1 and Th1 cells (CD4+ IFN-γ+ cells), we found that the patient’s serum can inhibited IFN γ-induced CD4+ T cells’ STAT-1 phosphorylation and Th1 cell differentiation in normal peripheral blood mononuclear cells, but this phenomenon was not observed in normal control’s serum. In addition, the higher serum concentration in the culture medium, the more obvious inhibition of Th1 cell differentiation.ConclusionsFor HIV-negative individuals with relapsing, refractory, fatal double or multiple intracellular pathogen infections, especially Talaromyces marneffei, clinicians should be aware that if they might be dealing with adult-onset immunodeficiency syndrome due to high-titer anti-IFN-γ autoantibodies. Systematic genetic and immunological investigations should also be performed.

COVID-19 in Socially Vulnerable Patients with Tuberculosis in Brazil

INTRODUCTION: COVID-19 is a global public health problem. The first case reported in the socially vulnerable population in the territory of Mato Grosso do State/Brazil occurred in August 2020. However, information about the co-infection of Tuberculosis (TB) and COVID-19 is rarely described in the world literature. Objective: to describe for the first time a group of vulnerable patients who died or not due to Tuberculosis and COVID-19, using a Cohort study of a control group and a treatment group. &#x0D; &#x0D; METHODS: Reporting 7 cases of TB associated with COVID-19 confirmed by respiratory RT-PCR, hospitalized in a hospital department of COVID-19 (CEAA: 42969320.0.0000.0021).&#x0D; &#x0D; RESULTS: The patients included in this case report were aged between 19 and 83 years, respectively, with a predominance of females, 4 patients were vaccinated with BCG. In addition, 3 patients died from COVID-19, and 2 patients were considered cured by COVID-19. The mean time to diagnosis between Tuberculosis and COVID-19 in the &amp;ldquo;control group&amp;rdquo; was 43 days and the mean time to diagnosis in the &amp;ldquo;treatment group&amp;rdquo; was 37 days. The average number of days of hospital stay in the &amp;ldquo;control group&amp;rdquo; was 50 days and in the &amp;ldquo;treatment group&amp;rdquo; it was 40 days. In the patients in the &amp;ldquo;control group&amp;rdquo;, 2 presented a unilateral pulmonary cavity lesion on the X-ray. In the &amp;ldquo;treatment group&amp;rdquo;, only 1 patient presented a unilateral pulmonary cavity lesion on the X-ray, and 2 presented a bilateral pulmonary cavity lesion, and only one developed bilateral non-cavitary lesion with infiltrates. Regarding drug resistance to the treatment of Tuberculosis, in the &amp;ldquo;treatment group&amp;rdquo; only 2 patients were sensitive and 3 were resistant. On the other hand, in the &amp;ldquo;control group&amp;rdquo;, 1 patient presented resistance and 1 sensitivity. It was found that 4 patients with drug resistance to Tuberculosis died (57%). Among the patients who died, it was observed that patients aged 83, 70 years and 66 years were not vaccinated with Bacillus Calmette-Gu&amp;eacute;rin (BCG). It was found in this case report that patients with COVID-19 and Tuberculosis have 60% less chance of cure. Furthermore, patients cured with pulmonary sequelae of COVID-19 may be at greater risk of developing advances in the worsening of Tuberculosis in the future. However, according to the results found in this case report, in some socially vulnerable regions where the forms of advanced Tuberculosis occur there is the presence of drug-resistant Mycobacterium Tuberculosis strains. &#x0D; &#x0D; CONCLUSION: Our study showed that Mycobactrium tuberculosis (MTB) infection in the socially vulnerable population increased the susceptibility to SARS-CoV-2 and the severity of COVID-19 or vice-versa. Based on this case report, it is recommended that, in the socially vulnerable population, the status of MTB infection be verified in patients with suspected COVID-19 at hospital admission.

Growth and the pubertal growth spurt in South African adolescents living with perinatally-acquired HIV infection.

The majority children living with HIV infection now survive into adulthood because of effective antiretroviral therapy (ART), but few data exist on their growth during adolescent years. This study investigated growth patterns and evaluated factors associated with suboptimal growth in adolescents with perinatally-acquired HIV infection. This retrospective cohort study included HIV-infected adolescents, aged 13 to 18 years, with at least 5 years of ART follow-up at a large HIV clinic in the Gauteng Province, South Africa. Weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores were calculated using World Health Organization (WHO) growth standards. Growth velocity graphs were generated utilising the mean height change calculated at 6-monthly intervals, using all available data after ART initiation, to calculate the annual change. Other collected data included WHO HIV disease staging, CD4%, HIV viral loads (VLs), ART regimens and tuberculosis co-infection. Included were 288 children with a median age of 6.5 years (IQR 4.2;8.6 years) at ART initiation, and 51.7% were male. At baseline the majority of children had severe disease (92% WHO stages 3&4) and were started on non-nucleoside reverse transcriptase inhibitor-based regimens (79.2%). The median CD4% was 13.5% (IQR 7.9;18.9) and median HIV viral load log 5.0 (IQR 4.4;5.5). Baseline stunting (HAZ <-2) was prevalent (55.9%), with a median HAZ of -2.2 (IQR -3.1;-1.3). The median WAZ was -1.5 (IQR -2.5;-0.8), with 29.2% being underweight-for-age (WAZ <-2). The peak height velocity (PHV) in adolescents with baseline stage 3 disease was higher than for those with stage 4 disease. Being older at ART start (p<0.001) and baseline stunting (p<0.001) were associated with poorer growth, resulting in a lower HAZ at study exit, with boys more significantly affected than girls (p<0.001). Suboptimal growth in adolescents with perinatally-acquired HIV infection is a significant health concern, especially in children who started ART later in terms of age and who had baseline stunting and is more pronounced in boys than in girls.

Co-infection of COVID-19 and Tuberculosis.

OBJECTIVE : Tuberculosis and COVID-19 diseases occur more frequently in people with similar risk factors. This study aimed to share the data on active tuberculosis patients during the severe acute respiratory syndrome coronavirus 2 pandemic.MATERIAL AND METHODSThe registration information of TB outpatient clinic between November 1, 2019, and April 20, 2020, was screened. A 7-question survey was administered to the patients who were diagnosed with active tuberculosis and who were agreed to participate in the study.ResultsA total of 309 patients with active tuberculosis were evaluated, the average age of the patients was 42.5 ± 18.5 years, and 70% were male. The percentage of having at least 1 comorbidity was 30.4%. The percentage of coronavirus disease 2019 disease in our study population was 1.9%; none of the patients of coronavirus disease 2019 were taken into the intensive care unit or dead due to clinical deterioration and/or respiratory failure. On the other hand, in this process it was announced that 146 457 cases were diagnosed with coronavirus disease 2019 throughout the country, of which 72% had inpatient treatment, 2% died, and 944 patients were still being treated in the intensive care unit, of which 490 were intubated. The positivity ratio of the reverse transcription-polymerase chain reaction test was 20.0% in the study group, while 20.3% in the İstanbul population. ConclusionTuberculosis patients might be more disadvantageous than the normal population in terms of the risk of exposure to severe acute respiratory syndrome coronavirus 2, but this does not cause an increase in the frequency and severity of coronavirus disease 2019 disease in active tuberculosis patients.

HIV, Tuberculosis, and Food Insecurity in Africa-A Syndemics-Based Scoping Review.

The double burden of HIV/AIDS and tuberculosis (TB), coupled with endemic and problematic food insecurity in Africa, can interact to negatively impact health outcomes, creating a syndemic. For people living with HIV/AIDS (PWH), food insecurity is a significant risk factor for acquiring TB due to the strong nutritional influences and co-occurring contextual barriers. We aim to synthesize evidence on the syndemic relationship between HIV/AIDS and TB co-infection and food insecurity in Africa. We conducted a scoping review of studies in Africa that included co-infected adults and children, with evidence of food insecurity, characterized by insufficient to lack of access to macronutrients. We sourced information from major public health databases. Qualitative, narrative analysis was used to synthesize the data. Of 1072 articles screened, 18 articles discussed the syndemic effect of HIV/AIDS and TB co-infection and food insecurity. Reporting of food insecurity was inconsistent, however, five studies estimated it using a validated scale. Food insecure co-infected adults had an average BMI of 16.5–18.5 kg/m2. Negative outcomes include death (n = 6 studies), depression (n = 1 study), treatment non-adherence, weight loss, wasting, opportunistic infections, TB-related lung diseases, lethargy. Food insecurity was a precursor to co-infection, especially with the onset/increased incidence of TB in PWH. Economic, social, and facility-level factors influenced the negative impact of food insecurity on the health of co-infected individuals. Nutritional support, economic relief, and psychosocial support minimized the harmful effects of food insecurity in HIV–TB populations. Interventions that tackle one or more components of a syndemic interaction can have beneficial effects on health outcomes and experiences of PWH with TB in Africa.

Co-infections, comorbidities, and alcohol or other substances abuses in chronic hepatitis C-related hospitalisations in Spain

BackgroundThe Strategic Plan for Tackling Hepatitis C launched in 2015 in Spain has led to an important nationwide decrease in hepatitis C related hospitalisation rates. However, patients’ infection progression during decades could increase their health status complexity and challenge patient's prognosis after hepatitis C eradication. MethodsWe carried out an observational retrospective study evaluating the prevalence of the main co-infections, comorbidities (risk factors and extrahepatic manifestations), and alcohol or other substances abuses in chronic hepatitis C related hospitalised patients in Spain. Data were obtained from the National Hospitalisation Registry discharges from January 1st of 2012 to December 31st of 2019. ResultsBetween 2012 and 2019 there were 356,197 chronic hepatitis C-related hospitalisations. In-hospital deaths occurred in 11,558 (4.6%) non-advanced liver disease and in 10,873 (10.4%) advanced liver disease-related hospitalisations.Compared to 2012–2015, in 2016–2019 the proportion of hospitalisations related to non-advanced liver disease increased from 69.4% to 72.4%, while the advanced disease-related hospitalisations decreased from 30.6% to 27.6% (P<.001). In spite of the decrease in severe cases among hospitalisations, all comorbidities evaluated, and alcohol abuse increased in 2016–2019 compared to 2012–2015, while co-infections and other substances abuses decreased in the same period.In the latest period (2016–2019): 28,679 (18.3%) of the hospitalised patients had a HIV, 6928 (4.4%) a hepatitis B, and 972 (.6%) a tuberculosis co-infection. Most frequent comorbidities were diabetes (N=33,622; 21.5%); moderate to severe renal disease (N=28,042; 17.9%), chronic obstructive pulmonary disease and asthma (N=25,559; 16.3%), and malignant neoplasms (excluding hepatocellular carcinoma) (N=19,873; 12.7%). Alcohol or substances abuse was reported in 48,506 (31.0%) hospitalisations: 30,782 (19.7%) with alcohol; 29,388 (18.8%) with other substances; and 11,664 (7.5%) with both, alcohol and other substances, abuses. ConclusionsDespite the reduction in advanced liver disease hepatitis C-related hospitalisations due to prioritisation of treatment to the more severe cases, high and increasing prevalence of comorbidities and risks factors among hepatitis C-related hospitalisations have been found.

In Vitro Potential of the Acetone Leaf Extract and Fractions of Psychotria capensis (Eckl.) Vatke (Rubiaceae) to Combat Co-Infection of Tuberculosis and Helminthiasis.

Tuberculosis (TB) is a disease of global importance that affects millions of people. Approximately a quarter of the world’s population is currently infected with M. tuberculosis, and about 10% of those infected will develop into active disease, particularly immune compromised individuals. Helminthiasis is of global health importance, affecting over 2 billion people mostly in resource-poor countries. Co-infection with tuberculosis (TB) and helminths (worms) is an emerging global public health concern with both affecting about one-third of the global population. Chronic infection with helminths can result in impaired immune responses to TB as well as enhancing failure to TB therapy and BCG vaccination. Antimycobacterial and anthelmintic activities of the acetone extract and fractions of Psychotria capensis were evaluated, including their in vitro safety. In addition, the anti-inflammatory and immunomodulatory effect of the fractions and crude extract of P. capensis were assessed. Antimycobacterial activity of the extract and fractions was tested against four non-tuberculous mycobacteria (Mycobacterium smegmatis, M. fortuitum, M. aurum, M. bovis BCG) and pathogenic M. tuberculosis H37Rv while the Egg Hatch Assay (EHA) was used for the anthelmintic test on eggs of Haemonchus contortus. Cytotoxicity was determined against Vero kidney cells while in vitro immune modulation via cytokine production was determined on activated macrophages. The minimum inhibitory concentration (MIC) values of the Psychotria capensis acetone extract and fractions ranged from 39 to 1,250 μg/ml with the crude extract and hexane fraction having the best MIC values (both 39 μg/ml). In the EHA, the inhibitory concentration (IC50) ranged from 160 to 630 μg/ml with the hexane fraction having the best activity. The hexane and chloroform fractions were relatively non-toxic with LC50 values of 290 and 248 μg/ml respectively, while the acetone crude extract (64 μg/ml) and n-butanol fraction (71 μg/ml) were moderately toxic. The SI values (LC50/MIC) ranged from 0.1 to 7.4 with the hexane fraction having the highest value against M. smegmatis (7.4). The hexane fraction had the best dual anthelmintic and antimycobacterial activity. This fraction had the best NO inhibitory activity and was the least cytotoxic, indicating that its activity was not due to general metabolic toxicity, with 96.54% cell viability. Pro-inflammatory cytokines such as IL-12p70 were upregulated while IL-10 expression was inhibited by the extracts. Compounds were detected using GC-MS analysis, and in both the crude acetone extract and the hexane fraction was the diterpene neophytadiene, which has anti-inflammatory and antimicrobial activity. Finding alternative or complementary approaches to dealing with TB infections by, amongst other things, reducing the incidence of helminth infestations may lessen the burden of TB, contributing to slowing the spread of multi-drug resistance.