Prednisolone and<i>Mycobacterium indicus pranii</i>in Tuberculous Pericarditis

Ntsekhe, Mpiko; Bosch, Jackie; Pandie, Shaheen; Jung, Ho Joong; Gumedze, Freedom; Pogue, Janice; Thabane, Lehana; Śmieja, Marek; Francis, Veronica; Joldersma, L.; Thomas, Baby; Damasceno, Albertino; Brown, Basil; Manga, Pravin; Kirenga, Bruce; Mondo, Charles; Mntla, Pindile; Peters, Ferande; Hakim, James; Matenga, Jonathan; Olunuga, Taiwo; Ogah, O.; Ansa, Victor; Aje, Akinyemi; Danbauchi, S. S.; Ojji, Dike; Yusuf, Salim; Act, Abstr

doi:10.1056/nejmoa1407380

Cited by 245 publications

(248 citation statements)

References 27 publications

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“…As for HHV-8 infection, immunosuppression is clearly a major contributor to progression to Kaposi sarcoma, whereas recent evidence points out the importance of complex immune modulation mechanisms [35]. Questions remain as to how cART interferes with such mechanisms.…”

Section: Discussionmentioning

confidence: 99%

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Immediate Antiretroviral Therapy Reduces Risk of Infection-Related Cancer During Early HIV Infection

et al. 2016

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Background. In the Strategic Timing of Antiretroviral Treatment (START) study, immediate combination antiretroviral therapy (cART) initiation reduced cancer risk by 64%. We hypothesized that risk reduction was higher for infection-related cancer and determined by differences in CD4 cell counts and human immunodeficiency virus (HIV) RNA between the study arms.Methods. Incident malignancies in START were categorized into infection-related and infection-unrelated cancer. We used Cox models to assess factors associated with both cancer categories. We used sequential adjustment for baseline covariates, cancer risk factors, and HIV-specific variables to investigate potential mediators of cancer risk reduction with immediate cART.Results. There were 14 cancers among persons randomized to immediate cART (6 infection-related and 8 infection-unrelated) and 39 cancers in the deferred arm (23 infection-related and 16 infection-unrelated); hazard ratios of immediate vs deferred cART initiation were 0.26 (95% confidence interval [CI], .11-.64) for infection-related and 0.49 (95% CI, .21-1.15) for infection-unrelated cancer. Independent predictors of infection-related cancer were older age, higher body mass index, low-to middle-income region, HIV RNA, and baseline CD8 cell count. Older age and baseline CD8 cell count were independent predictors of infection-unrelated cancer. Adjustment for latest HIV RNA level had little impact on the protective effect of immediate cART on infection-related cancer. Adjustment for latest HIV RNA level, but not for CD4 cell count or cancer risk factors, attenuated the effect of immediate cART on infection-unrelated cancer.Conclusions. Immediate cART initiation significantly reduces risk of cancer. Although limited by small sample size, this benefit does not appear to be solely attributable to HIV RNA suppression and may be also mediated by other mechanisms.

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Section: Discussionmentioning

confidence: 99%

“…Questions remain as to how cART interferes with such mechanisms. In a randomized trial involving participants with tuberculous pericarditis predominantly coinfected with HIV, glucocorticoids and immunotherapy with nonpathogenic mycobacteria acted synergistically to increase risk of Kaposi sarcoma [35].…”

Section: Discussionmentioning

confidence: 99%

Immediate Antiretroviral Therapy Reduces Risk of Infection-Related Cancer During Early HIV Infection

et al. 2016

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“…However, the rate of constrictive pericarditis and hospitalization were lower in the group receiving prednisolone as compared to those receiving placebo. There was an increase in human immunodeficiency virus (HIV)-related cancers in the prednisolone group [62]. …”

Section: Use Of Steroidsmentioning

confidence: 99%

Current therapies for the treatment of multidrug-resistant tuberculosis in children in India

Mukherjee

Lodha

Kabra

2017

Expert Opinion on Pharmacotherapy

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Introduction: Multidrug-resistant tuberculosis (MDR-TB) is a serious life threatening condition affecting children as well as adults worldwide. Timely diagnosis and effective treatment, both of which are complex in children, are the prerogatives for a favorable outcome.Areas covered: This review covers epidemiology, treatment regimen and duration, newer drugs and adverse events in children with MDR-TB. Special note has been made of epidemiology and principles of treatment followed in Indian children.Expert opinion: High index of suspicion is essential for diagnosing childhood MDR-TB. If there is high probability, a child can be diagnosed as presumptive MDR-TB and started on empiric treatment in consultation with experts. However, every effort should be made to confirm the diagnosis. Backbone of an effective MDR-TB regimen consists of four 2nd line anti-TB drugs plus pyrazinamide; duration being 18–24 months. The newer drugs delamanid and bedaquiline can be used in younger children if no other alternatives are available after consultation with experts. Wider availability of these drugs should be ensured for benefit to all concerned. More research is required for development of new and repurposed drugs to combat MDR-TB. Children need to be included in clinical trials for such life-saving drugs, so that nobody is denied the benefits.

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“…More recently, the IMPI trial evaluated the value of adding adjunctive high-dose oral prednisolone for 6 weeks to anti-TB therapy in both HIV+ and -patients with TBP. (13) Two thirds of the 1 400 participants underwent pericardiocentesis and a definite diagnosis of TBP was established in approximately 16%. Adjunctive oral prednisolone had a neutral effect on the combined primary outcome of death from all causes, cardiac tamponade requiring pericardiocentesis and pericardial constriction.…”

Section: The Controversial Role Of Steroidsmentioning

confidence: 99%

“…To date, no adjunctive therapy has been proven to alter the rate of death from constriction in TBP. (10)(11)(12)(13) Tuberculous meningitis, another extrapulmonary manifestation of the disease, which is also responsible for considerable morbidity and mortality, has recently been the target of an attempt at an intensified…”

Section: Introductionmentioning

confidence: 99%