ABSTRACT
The aim of the present research was to study the capability of a genotyping method for M. tuberculosis through detection of six VNTR-loci (MIRU10, MIRU26, MIRU31, MIRU39, MIRU40, ETR-A). Loci MIRU10, MIRU26, MIRU40 and ETR-A have exhibited high polymorphism in group non-Beijing, while loci MIRU26 and MIRU31 - in the Beijing family. A combined detection of all six loci for fingerprinting of the isolates both from Beijing and non-Beijing was highly effective (Hunter-Gaston index was 0.88 and 0.93 correspondently), especially in areas with limited financial resources and high prevalence of multidrug resistant M. tuberculosis strains.
Subject(s)
Multilocus Sequence Typing/methods , Mycobacterium tuberculosis/genetics , Mycobacterium tuberculosis/isolation & purification , Tuberculosis/microbiology , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/genetics , Drug Resistance, Bacterial , Genotype , Humans , Minisatellite Repeats , Mycobacterium tuberculosis/classification , Mycobacterium tuberculosis/drug effectsABSTRACT
Previously, an increase in clinical effectiveness of the antituberculosis treatment (ATT) and antiretroviral therapy (ART) in case of additional immunoglobulin G (IgG) administration in patients with multidrug-resistant tuberculosis (MDR-TB)/HIV coinfection was reported. The aim of this study was to investigate the impact of IgG administration in addition to the standard second-line ATT and ART on the humoral immunity status in patients with MDR-TB/HIV coinfection immune deficiency. The study involved 52 patients living with HIV with MDR-TB coinfection and CD4+ lymphocyte cell count below 50 cells/µCL. Patients in the control group and intervention group received the second-line ATT and ART; in addition, patients in the intervention group received IgG intravenously. The humoral immunity status was evaluated by measurement of IgA, IgE, IgG, and IgM in plasma. The standard ATT and ART resulted in a two-step change in humoral immunity: IgM, IgG, IgA, and IgE levels gradually increased to a maximal level at the 5-month mark and started to gradually decrease after the 8-month mark. Addition of IgG to the standard therapy resulted in a steeper decrease in the immunoglobulin level in serum, especially IgG, compared with standard therapy alone, allowing for an earlier initiation of ART in patients in the intervention group.
Subject(s)
Coinfection , HIV Infections , Tuberculosis, Multidrug-Resistant , Tuberculosis , Humans , HIV Infections/complications , HIV Infections/drug therapy , Antitubercular Agents/therapeutic use , Antitubercular Agents/adverse effects , Immunoglobulin G , Immunity, Humoral , Tuberculosis/complications , Tuberculosis/drug therapy , Tuberculosis, Multidrug-Resistant/drug therapy , Coinfection/drug therapy , Immunoglobulin A , Immunoglobulin E/therapeutic use , Immunoglobulin M/therapeutic useABSTRACT
Context: Treatment of the patients with multidrug-resistant tuberculosis (MDR-TB)/HIV coinfection in a state of severely suppressed immune system remains under efficient. Aims: The aim of this study was to assess the effectiveness of adjuvant immunoglobulin therapy in TB/HIV patients. Settings and Design: The relationship between biochemical indexes in the patients with MDR-TB/HIV co-infection and adjuvant immunoglobulin therapy. Materials and Methods: The study involved 52 HIV-positive patients with MDR-TB and CD4+ lymphocyte cells below 50 cells/µCL. Patients in control group (Group 1) and in basic group (Group 2) received standard treatment with second-line antituberculosis agents and antiretroviral agents. In addition patients in basic group were treated by immunoglobulin G intravenously. The evaluation of biochemical parameters such as bilirubin level, thymol test, the activity of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) was carried out on automatic analyzer HumaStar 300 at the beginning and after 0.5-8 months of treatment. Statistical analysis was performed using the Statistica 10.0 software (Stat. Soft Inc., USA). Kruskal-Wallis, ANOVA, and Chi-square tests were used in this study. Results: After 8 months of treatment, studied biochemical indexes were lower in Group 2 than in patients from Group 1. For example, the number of patients in Group 2 with increased bilirubin level was 1.7 times more than in Group 1 (p < 0.05), with increased ALT, AST, or GGT activity in 2.5 times (p < 0.01), 2.7 times (p < 0.01), or 2.4 times (p < 0.05) correspondently, comparatively with Group 1. Conclusion: The usage of immunoglobulins intravenously in the group of patients with MDR-TB associated with HIV infection, with CD4+ level <50 cells/µCL, is appropriate and essential because it improves treatment outcome.