Background Most studies assessing drug resistant tuberculosis (DRTB) in human immunodeficiency virus (HIV) co-infected patients in India have used conventional culture- based systems to diagnose DRTB that have a longer turnaround time leading to risk of amplification of resistance to an empirical regimen. We determined the prevalence of DRTB amongst people living with HIV (PLHIV) using the line probe assay and determined risk factors associated with the presence of multi drug resistant tuberculosis (MDRTB). Methods A Cross-sectional study was undertaken at Poona Hospital and Research Center (PHRC) and the Institute of Infectious Diseases, two tertiary level private care centers in Pune, India. Consenting PLHIV with confirmed Pulmonary TB (PTB) and/or extra-pulmonary TB (EPTB) diagnosed based on detection of Mycobacterium TB by line probe assay (Geno Type MTBDRplus version 2) on clinical specimens were included. Those with documented past history of DRTB were excluded. Resistance against anti-TB drugs was determined by the same assay. The prevalence of any form of drug resistant TB (DRTB), MDRTB, Rifampicin resistant TB (RRTB) and Isoniazid (INH) mono-resistant TB were determined as the proportion of these amongst all included PLHIV-TB. A multivariate analysis was conducted to determine risk factors that were statistically associated with MDRTB, DRTB, RRTB and INH mono-resistant TB. Results Two hundred PLHIV were recruited. The prevalence (95% CI) of MDRTB, INH mono- resistance and RR resistance was 12.5% (7.9–17.1%), 9% (6.9–11.2%) and 2.5% (1.4–3.6%), respectively. The prevalence (95% CI) of MDRTB among new and relapsed patients was 8.8% (6.5–11.1%) and 23.1% (17.2–28.9%), respectively. Tuberculosis relapse was the only factor significantly associated with MDRTB, DRTB and INH mono-resistant TB. Conclusion We document a high prevalence of drug resistance to anti-TB drugs including MDRTB among PLHIV in our setting using Geno Type MTBDRplus directly on clinical specimens. This validates the WHO recommendation of performing routine rapid molecular resistance testing prior to initiating anti-TB treatment among all PLHIV with presumptive TB. Using rapid molecular testing especially Geno Type MTBDRplus (that detects resistance to INH and Rifampicin simultaneously) reduces the turn-around time helping in optimizing treatment.

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Introduction: Recent studies suggest that sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective at slowing the progression of kidney disease and lowering the risk of kidney failure in people with kidney disease and type 2 diabetes. There is no such study from India. The present study was performed to evaluate the effects of SGLT2i in Indian patients with diabetes and chronic kidney disease (CKD). Materials and Methods: This prospective study included 86 patients with diabetes and chronic kidney disease and with an estimated creatinine clearance of >30 mL/minute. Forty-one patients received SGLT2i and 45 patients did not receive SGLT2i. Patients were followed up for at least 12 months. Body mass index (BMI), blood pressure, HbA1c, urine protein to creatinine ratio (UPCR), doubling of serum creatinine and rate of decline of the estimated creatinine clearance were compared between the two groups. Results: The two groups were comparable at baseline in terms of age, sex, blood pressure, BMI, HbA1c, and degree of renal impairment. Over 12 months the UPCR decreased by 0.03 in SGLT2i group and increased by 1.1 in non SGLT2i group (P < 0.05). Doubling of serum creatinine occurred in 4.8% of patients in the SGLT2i group as compared to 18% in the control group (P < 0.05). The rate of decline of the estimated creatinine clearance in the SGLT2i group was 4.9 ml/min/year as compared to 9.4 ml/min/year in the non SGLT2i group (P < 0.05). At 12 months the BMI in the SGLT2i group decreased by 1.49 as compared to 0.12 in the non SGLT2i group (P < 0.05). The blood pressure and HbA1c control were similar in both groups during the study period suggesting that the observed effect was due to SGLT2 inhibition itself and not due to blood pressure or blood glucose control. Conclusion: Our study showed that treatment with SGLT2i had significant renoprotective effects, as shown by a reduction in urinary protein excretion, less percentage of patients developing doubling of serum creatinine, and a slower rate of decline in creatinine clearance.

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With recent advances in the treatment of human immunodeficiency virus (HIV), renal transplantation is no longer considered a contraindication in properly selected HIV-positive patients. Several studies have demonstrated comparable patient and graft outcomes between HIV-negative and HIV-positive renal transplant recipients. Most of the information on outcomes of HIV-positive to HIV-positive transplantation is based on data from deceased donors. There are only a handful of case reports about living donor renal transplantation in an HIV-positive patient from an HIV-positive donor. Furthermore, there is no report in the world of preemptive living donor renal transplantation in this setting. Here, we report a case of successful preemptive renal transplantation in an HIV-positive recipient from an HIV-positive living donor performed at our center.