How Soon after Infection with HIV Does the Risk of Tuberculosis Start to Increase? A Retrospective Cohort Study in South African Gold Miners

Sonnenberg, Pam; Glynn, Judith R.; Fielding, Katherine; Murray, Jill; Godfrey‐Faussett, Peter; Shearer, Stuart

doi:10.1086/426827

Cited by 370 publications

(286 citation statements)

References 41 publications

Supporting

Mentioning

269

Contrasting

Unclassified

Order By: Relevance

“…Renewed global interest led to advances in recognising TB/HIV co-infection and understanding the mechanisms promoting susceptibility of HIV-infected people in developing TB disease as part of a multifactorial process [26-30]. Diagnosis of HIV/TB co-infection in children is still challenging.…”

Section: Resultsmentioning

confidence: 99%

“…Risk of active TB increases with depletion of CD4 T-cells, but studies have also shown that HIV positive individuals in high TB incidence regions have an increased risk of developing active TB in the first year after HIV seroconversion, i.e. with high CD4 T-cell counts [26]. In addition, HIV positive individuals on ART with high CD4 T-cell counts continue to have an increased risk of developing TB compared with uninfected controls.…”

Section: Impact Of Hiv On Pathogenesis Of Tbmentioning

confidence: 99%

See 1 more Smart Citation

Tuberculosis and HIV co-infection in children

et al. 2014

View full text Add to dashboard Cite

HIV is the top and tuberculosis is the second leading cause of death from infectious disease worldwide, with an estimated 8.7 million incident cases of tuberculosis and 2.5 million new HIV infections annually. The World Health Organization estimates that HIV prevalence among children with tuberculosis, in countries with moderate to high prevalence, ranges from 10 to 60%. The mechanisms promoting susceptibility of people with HIV to tuberculosis disease are incompletely understood, being likely caused by multifactorial processes.Paediatric tuberculosis and HIV have overlapping clinical manifestations, which could lead to missed or late diagnosis. Although every effort should be made to obtain a microbiologically-confirmed diagnosis in children with tuberculosis, in reality this may only be achieved in a minority, reflecting their paucibacillary nature and the difficulties in obtain samples. Rapid polymerase chain reaction tests, such as Xpert MTB/RIF assay, are increasingly used in children. The use of less or non invasive methods of sample collection, such as naso-pharyngeal aspirates and stool samples for a polymerase chain reaction-based diagnostic test tests and mycobacterial cultures is promising technique in HIV negative and HIV positive children. Anti-tuberculosis treatment should be started immediately at diagnosis with a four drug regimen, irrespective of the disease severity. Moreover, tuberculosis disease in an HIV infected child is considered to be a clinical indication for initiation of antiretroviral treatment. The World Health Organization recommends starting antiretroviral treatment in children as soon as anti-tuberculosis treatment is tolerated and within 2- 8 weeks after initiating it. The treatment of choice depends on the child’s age and availability of age-appropriate formulations, and potential drug interactions and resistance. Treatment of multi-drug resistant tuberculosis in HIV-infected children follows same principles as for HIV uninfected children. There are conflicting results on effectiveness of isoniazid preventive therapy in reducing incidence of tuberculosis disease in children with HIV.ConclusionData on HIV/TB co-infection in children are still lacking. There are on-going large clinical trials on the prevention and treatment of TB/HIV infection in children that hopefully will help to guide an evidence-based clinical practice in both resource-rich and resource-limited settings.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Impact Of Hiv On Pathogenesis Of Tbmentioning

confidence: 99%

Tuberculosis and HIV co-infection in children

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Unlike other opportunistic infections, the risk of developing active TB is greatly increased in persons even before significant depletion of CD4 1 T cells in peripheral blood (2). In high transmission regions, most TB cases in HIV-individuals result from recent Mycobacterium tuberculosis (Mtb) infection indicating that in these individuals the lung is more permissive for the establishment or progression of primary infections (3).…”

mentioning

confidence: 99%

Asymptomatic HIV-infected Individuals on Antiretroviral Therapy Exhibit Impaired Lung CD4⁺T-Cell Responses to Mycobacteria

Jambo

Banda

Afran

et al. 2014

Am J Respir Crit Care Med

View full text Add to dashboard Cite

Rationale: HIV-infected persons on antiretroviral therapy (ART) remain at higher risk of pulmonary tuberculosis (TB) than HIV-uninfected individuals. This increased susceptibility may be caused by impairment of alveolar macrophage (AM) function and/or mycobacteria-specific alveolar CD4 1 T-cell responses observed in HIV-infected ART-naive adults.Objectives: To determine whether ART was associated with improvement in both AM function, assessed by phagosomal proteolysis, and alveolar CD4 1 T-cell responses to Mycobacterium in HIV-infected individuals.Methods: Peripheral blood was drawn and bronchoalveolar lavage (BAL) performed on healthy, 35 HIV-uninfected, 25 HIV-infected ART-naive, and 50 HIV-infected ART-treated asymptomatic adults. Phagosomal proteolysis of AM was assessed with fluorogenic beads. Mycobacteria-specific CD4 1 T-cell responses were measured by intracellular cytokine staining.Measurements and Main Results: HIV-infected adults on ART exhibited lower plasma HIV viral load and higher blood CD4 1 T-cell count than ART-naive adults. AM proteolysis and total mycobacteria-specific Th1 CD4 1 T-cell responses in individuals on ART for greater than or equal to 4 years were similar to HIVuninfected control subjects but those on ART for less than 4 years had impaired responses. Total influenza-specific alveolar Th1 CD4 1 Tcell responses were intact in all individuals receiving ART. In contrast, BAL and blood mycobacteria-specific polyfunctional CD4 1 T-cell responses were impaired in adults on ART irrespective of duration.Conclusions: AM and mycobacteria-specific alveolar CD4 1 T-cell responses in HIV-infected adults on ART for less than 4 years are impaired and may partly explain the high risk of TB in HIV-infected individuals on ART. Strategies to augment ART to improve lung immune cell function and reduce the high incidence of TB in HIVinfected adults who initiate ART should be investigated.

show abstract

“…The mortality rate has reached 20% in that region, compared to 5% in countries with good tuberculosis control programs [3]. Moreover, there is an annual increase of 10% in the number of TB cases in these African countries, mainly among individuals between 15 and 49 years old [5].…”

mentioning

confidence: 99%

“…The risk of developing active TB in HIV patients increases from 5 to 15% annually, due to the latent infection being reactivated; this depends on the degree of immunocompromise [12,14,15]. A study conducted among gold miners in South Africa showed that the risk of TB doubles within one year of HIV infection, but only increases slightly during the following years [5]. It has been noted that pulmonary TB occurs relatively early in the spectrum of HIV related infections and often before other AIDS-defining conditions.…”

mentioning

confidence: 99%

Factors related to HIV/tuberculosis coinfection in a Brazilian reference hospital

Carvalho¹,

Monteiro²,

Neto³

et al. 2008

Braz J Infect Dis

View full text Add to dashboard Cite

Infection with both Human Immunodeficiency Virus (HIV) and Mycobacterium tuberculosis is currently the world's leading cause of death due to infectious agents. We evaluated factors related to the development of tuberculosis (TB) in HIV-infected patients who were being treated at an infectious diseases hospital in Fortaleza, Ceará, Brazil. From January 2004 to December 2005, we made an epidemiological study through the analysis of the medical records of 171 patients, who were diagnosed as having both HIV and tuberculosis. Among these co-infected patients, most (81%, p=0.0006) were male. Co-infection was more frequent (87.8%) among patients over 40 years of age and those with lower educational levels (less than eight years of schooling). Forty-one percent of the patients in the study had not had a smear culture test for acid-fast bacilli (AFB). CD4 cell counts were lower than 200 cells/µ µ µ µ µL in 71.9% of the patients, the mean being 169 cells/µ µ µ µ µL. This type of data is important for establishing strategies to improve the control of tuberculosis in HIV-infected patients.

show abstract

How Soon after Infection with HIV Does the Risk of Tuberculosis Start to Increase? A Retrospective Cohort Study in South African Gold Miners

Abstract: The increase in the risk of TB so soon after infection with HIV was unexpected. Current predictive models of TB incidence underestimate the effect of HIV infection in areas where TB is endemic.

Cited by 370 publications

References 41 publications

Tuberculosis and HIV co-infection in children

Tuberculosis and HIV co-infection in children

Asymptomatic HIV-infected Individuals on Antiretroviral Therapy Exhibit Impaired Lung CD4⁺T-Cell Responses to Mycobacteria

Factors related to HIV/tuberculosis coinfection in a Brazilian reference hospital

Contact Info

Product

Resources

About

How Soon after Infection with HIV Does the Risk of Tuberculosis Start to Increase? A Retrospective Cohort Study in South African Gold Miners

Abstract: The increase in the risk of TB so soon after infection with HIV was unexpected. Current predictive models of TB incidence underestimate the effect of HIV infection in areas where TB is endemic.

Cited by 370 publications

References 41 publications

Tuberculosis and HIV co-infection in children

Tuberculosis and HIV co-infection in children

Asymptomatic HIV-infected Individuals on Antiretroviral Therapy Exhibit Impaired Lung CD4+T-Cell Responses to Mycobacteria

Factors related to HIV/tuberculosis coinfection in a Brazilian reference hospital

Contact Info

Product

Resources

About

Asymptomatic HIV-infected Individuals on Antiretroviral Therapy Exhibit Impaired Lung CD4⁺T-Cell Responses to Mycobacteria