S1 High Levels of Latent TB Infection, Blood Borne Viruses and Unmet Need Among Hard to Reach Groups in London: The TB Reach Study

Abstract

A4Thorax 2012;67(Suppl 2):A1-A204cosmopolitan urban settings where human populations of different ancestry intermingle. These different strains induce distinct patterns of cytokine and chemokine secretion ('inflammatory profiles') in human macrophages. Circulating and antigen-stimulated inflammatory profiles might therefore be expected to vary significantly between tuberculosis patients of different ethnic origin. We therefore conducted a study to determine whether such variation exists. Background Urban homeless people have high levels of disease and often present late for healthcare. Despite high rates of active TB in London's large homeless population, limited data are available regarding the prevalence of latent TB infection (LTBI) and blood borne viruses (BBV) -HIV, Hepatitis B & C. We have undertaken a TB/BBV screening programme to assess the prevalence of LTBI, infection with BBV and co-infection within hard to reach groups (homeless people and substance misusers) in homeless hostels and residential drug services in London. Method Residents screened for TB on a mobile chest x-ray unit were approached and with consent, blood was drawn for TB IGRA (Quantiferon In-Tube) and BBV. Results were fed back to participants with onward referral as necessary. Results Of 413 eligible participants, 390 (94%) reported a history of homelessness. Of these 390 participants, 89% were male, 68% were 16-49 years of age and 66% UK born. 17% were IGRA positive, 1% HIV positive (all previously known), and 10% had current and 4% past Hepatitis C. 1% of those screened had current Hepatitis B infection, 10% past infection, 18% had vaccine induced protective levels of immunity and 71% had insufficient or no Hepatitis B immunity. 29% of subjects with Hepatitis C were LTBI co-infected. Multivariate analysis identified increasing age e.g. (OR, 19.62; CI 95 ,. Conclusion Extremely high rates of LTBI, Hepatitis C and coinfection are present in our urban study population. Despite targeted Hepatitis B vaccination programmes, a high proportion of participants appear unvaccinated. These levels of unmet need have major implications for public and personal healthcare planning and should be recognised through appropriate targeted health and social policy.

Targeting the Intracellular Environment in Cystic Fibrosis: Restoring Autophagy as a Novel Strategy to Circumvent the CFTR Defect

“…A recent clinical trial with the most promising CFTR corrector, VX-809 (Van Goor et al, 2011), in F508del-CFTR homozygous patients demonstrated modest dose-dependent reductions in sweat chloride (Clancy et al, 2012). However, beyond this laboratory parameter, no improvement in lung function or CF complications was reported (Clancy et al, 2012; Elborn, 2012). …”

“…Therefore, combining CFTR correctors and potentiators may be a suitable approach for F508del-CFTR patients, provided that the corrector molecules are effective in increasing F508del-CFTR PM stability after rescue. Currently, phase II clinical studies evaluating the combination of VX-809 and the potentiator VX-770 in CF patients that express F508del-CFTR are underway (Elborn, 2012). …”