Determinants of coinfection tuberculosis and HIV in prisons in Brazil.

INTRODUCTION: Prisons context has the potential for the spread of infectious diseases, like HIV and tuberculosis, which prevalence is higher in the people deprived of liberty compared to the general population. OBJECTIVE: to analyze which are the determinants of coinfection tuberculosis and HIV in prisons. METHODOLOGY: Case-control study conducted in the state of São Paulo, Brazil. New cases of tuberculosis in the population deprived of liberty in the period between 2015 and 2017 were considered. Data were obtained through the notification and monitoring system for tuberculosis cases in the state of São Paulo and included sociodemographic and clinical variables and diagnosis and treatment information. The data were analyzed through frequency distribution and bivariate analysis, testing the association of the dependent variable (tuberculosis/HIV coinfection vs. tuberculosis/HIV non-coinfection) with independent variables (sociodemographic, clinical and diagnostics variables) by calculating the odds ratio and p-value. RESULTS: Among the determinants of tuberculosis/HIV coinfection in prisons, we identified: age between 26-35, 36-55 and 56-84 years, notification in hospitals, negative sputum smear microscopy and culture, X-ray suggestive of another pathology, extrapulmonary and mixed clinical form, and alcoholism. A high percentage of death was also identified among coinfected people. CONCLUSIONS: identifying the determinants of the tuberculosis/HIV coinfected individual can assist in the development and implementation of guidelines aimed at controlling both infections in the prison environment.

[Factors associated to survival in patients with HIV-TB in the Department of Infectious Diseases of the Arzobispo Loayza National Hospital, Perú, since 2004 to 2012]. / Factores asociados a sobrevida en pacientes con co-infección VIH-TBC en el Servicio de Infectología del Hospital Nacional Arzobispo Loayza, Perú, durante los años 2004-2012.

Background The main cause of death in HIV patients is tuberculosis (TB). However, few Latin American studies have evaluated the prognosis of patients with coinfection. Aim To determine the factors associated with survival in patients with HIV-TB coinfection treated at a Peruvian referral hospital. Methods A retrospective cohort study was performed based on clinical records of patients treated at the Department of Infectious Diseases in the Arzobispo Loayza National Hospital from 2004 to 2012. Survival was assessed using the Kaplan-Meier estimator and Cox Proportional Hazard Model. Results From 315 patients, 82 died during the follow-up. The mean of follow for each patient was 730 days. The multivariate analysis showed that receiving HAART (HR: 0,31; IC: 0,20-0,50; p < 0,01) and having more weight (HR: 0,96; IC 0,94-0,98; p < 0,01) when the coinfection was diagnosed, were protective factors; while having a pathology different from TB (HR: 1,88; IC: 1,19-2,98; p < 0,01), age in years (HR: 1,76; IC: 1,12-2,74; p ≤ 0,01) and being hospitalized when diagnosed with TB (HR: 1,69; IC 1,02-2,80; p < 0,04) were associated with lower survival. Discussion Receiving HAART and having more weight when the coinfection is diagnosed were associated with a higher chance of survival.

Factores asociados a sobrevida en pacientes con co-infección VIH-TBC en el Servicio de Infectología del Hospital Nacional Arzobispo Loayza, Perú, durante los años 2004-2012 / Factors associated to survival in patients with HIV-TB in the Department of Infectious Diseases of the Arzobispo Loayza National Hospital, Perú, since 2004 to 2012

Resumen Introducción La principal causa de muerte en pacientes infectados con VIH es la tuberculosis (TBC). Pocos estudios latinoamericanos han evaluado la sobrevida de pacientes co-infectados. Objetivo Determinar factores asociados a sobrevida en pacientes con co-infección VIH-TBC atendidos en un hospital peruano. Materiales y Métodos Estudio de cohorte, retrospectivo, en base a registros clínicos de pacientes atendidos en el Servicio de Infectología del Hospital Nacional Arzobispo Loayza durante los años 2004-2012. Se evaluó la sobrevida de 315 pacientes, utilizando las curvas de Kaplan-Meier y el método de Riesgos Proporcionales de Cox. Resultados De 315 pacientes, 82 murieron durante el seguimiento. La mediana de seguimiento para cada participante fue de 730 días. El análisis multivariado mostró que recibir TARGA (HR: 0,31; IC: 0,20-0,50; p < 0,01) y tener mayor peso (HR: 0,96; IC 0,94-0,98; p < 0,01) al momento del diagnóstico de la co-infección fueron factores protectores; mientras que tener una patología distinta a TBC (HR: 1,88; IC: 1,19-2,98; p < 0,01), edad mayor a 34 años (HR: 1,76; IC: 1,12-2,74; p ≤ 0,01), y estar hospitalizado al momento del diagnóstico (HR: 1,69; IC 1,02-2,80; p < 0,04) se asociaron a menor sobrevida. Discusión Recibir TARGA y tener mayor peso al momento del diagnóstico de la coinfección se asociaron a mayor sobrevida.

Background The main cause of death in HIV patients is tuberculosis (TB). However, few Latin American studies have evaluated the prognosis of patients with coinfection. Aim To determine the factors associated with survival in patients with HIV-TB coinfection treated at a Peruvian referral hospital. Methods A retrospective cohort study was performed based on clinical records of patients treated at the Department of Infectious Diseases in the Arzobispo Loayza National Hospital from 2004 to 2012. Survival was assessed using the Kaplan-Meier estimator and Cox Proportional Hazard Model. Results From 315 patients, 82 died during the follow-up. The mean of follow for each patient was 730 days. The multivariate analysis showed that receiving HAART (HR: 0,31; IC: 0,20-0,50; p < 0,01) and having more weight (HR: 0,96; IC 0,94-0,98; p < 0,01) when the coinfection was diagnosed, were protective factors; while having a pathology different from TB (HR: 1,88; IC: 1,19-2,98; p < 0,01), age in years (HR: 1,76; IC: 1,12-2,74; p ≤ 0,01) and being hospitalized when diagnosed with TB (HR: 1,69; IC 1,02-2,80; p < 0,04) were associated with lower survival. Discussion Receiving HAART and having more weight when the coinfection is diagnosed were associated with a higher chance of survival.

Risk factors for increased immune reconstitution in response to Mycobacterium tuberculosis antigens in tuberculosis HIV-infected, antiretroviral-naïve patients.

BACKGROUND: Little is known regarding the restoration of the specific immune response after combined antiretroviral therapy (cART) and anti-tuberculosis (TB) therapy introduction among TB-HIV patients. In this study, we examined the immune response of TB-HIV patients to Mycobacterium tuberculosis (Mtb) antigens to evaluate the response dynamics to different antigens over time. Moreover, we also evaluated the influence of two different doses of efavirenz and the factors associated with immune reconstitution. METHODS: This is a longitudinal study nested in a clinical trial, where cART was initiated during the baseline visit (D0), which occurred 30 ± 10 days after the introduction of anti-TB therapy. Follow-up visits were performed at 30, 60, 90 and 180 days after cART initiation. The production of IFN-γ upon in vitro stimulation with Mtb antigens purified protein derivative (PPD), ESAT-6 and 38 kDa/CFP-10 using ELISpot was examined at baseline and follow-up visits. RESULTS: Sixty-one patients, all ART-naïve, were selected and included in the immune reconstitution analysis; seven (11.5%) developed Immune Reconstitution Inflammatory Syndrome (IRIS). The Mtb specific immune response was higher for the PPD antigen followed by 38 kDa/CFP-10 and increased in the first 60 days after cART initiation. In multivariate analysis, the variables independently associated with increased IFN-γ production in response to PPD antigen were CD4+ T cell counts <200 cells/mm3 at baseline, age, site of tuberculosis, 800 mg efavirenz dose and follow-up CD4+ T cell counts. Moreover, the factors associated with the production of IFN-γ in response to 38 kDa/CFP-10 were detectable HIV viral load (VL) and CD4+ T cell counts at follow-up visits of ≥200 cells/mm3. CONCLUSIONS: These findings highlight the differences in immune response according to the specificity of the Mtb antigen, which contributes to a better understanding of TB-HIV immunopathogenesis. IFN-γ production elicited by PPD and 38 kDa/CFP-10 antigens have a greater magnitude compared to ESAT-6 and are associated with different factors. The low response to ESAT-6, even during immune restoration, suggests that this antigen is not adequate to assess the immune response of immunosuppressed TB-HIV patients.

Epidemiological study of hepatitis B virus among prisoners with active tuberculosis in Central Brazil.

BACKGROUND: Due to environmental and social conditions inherent to incarceration, tuberculosis (TB) and hepatitis B virus (HBV) are major diseases among prison inmates. OBJECTIVE: To determine overall and occult HBV infection (OBI) prevalence rates, risk factors and genotype distribution among inmates with active TB. STUDY DESIGN: A cross-sectional study was conducted among 216 inmates with active TB recruited at the largest prisons in Campo Grande, Mato Grosso do Sul, Central Brazil. The participants were interviewed and tested for the presence of serological markers for HBV infection. RESULTS: The overall prevalence of HBV infection (total hepatitis B core antibodies) was 10.2% (95%CI 6.2-14.2). HBV surface antigen (HBsAg) prevalence was 1.4% (3/216). HBV DNA was detected in all three HBsAg-positive samples and in 10.5% (2/19) of the anti-HBc-positive samples (OBI), giving a HBV-TB co-infection prevalence of 2.3% (5/216). A multivariate analysis of risk factors showed that history of sharing cutting instruments, length of incarceration and homosexual sex were associated with HBV infection. CONCLUSION: Our findings indicate that HBV remains an important public health concern among prison inmates and active TB-HBV co-infection needs to be addressed for effective treatment.

Ratio of monocytes to lymphocytes in peripheral blood in patients diagnosed with active tuberculosis

Objective: The ratio of monocytes to lymphocytes in peripheral blood could reflect an indi- vidual's immunity to Mycobacterium tuberculosis. The objective of this study was to evaluate the relationship between ratio of monocytes to lymphocytes and clinical status of patients with active tuberculosis. Methods: This was a retrospective review of data collected from the clinical database of The Fifth People's Hospital of Wuxi, Medical College of Jiangnan University. A total of 419 patients who had newly diagnosed active tuberculosis and 108 cases from 419 patients with tuberculosis therapy either near completion or completed were selected. Controls were 327 healthy donors. Results: Median ratio of monocytes to lymphocytes was 0.36 (IQR, 0.22-0.54) in patients before treatment, and 0.16 (IQR, 0.12-0.20) in controls (p < 0.001). Ratio of monocytes to lymphocytes <9% or >25% was significant predictors for active tuberculosis (OR = 114.73, 95% CI, 39.80-330.71; OR = 89.81, 95% CI, 53.18-151.68, respectively). After treatment, the median ratio of monocytes to lymphocytes recovered to be nearly normal. Compared to other patients, patients with extrapulmonary tuberculosis and of age >60 years were more likely to have extreme ratio of monocytes to lymphocytes (AOR = 2.57, 95% CI, 1.08-6.09; AOR = 4.36, 95% CI, 1.43-13.29, respectively). Conclusions: Ratio of monocytes to lymphocytes <9% or >25% is predictive of active tuberculosis. .

Ratio of monocytes to lymphocytes in peripheral blood in patients diagnosed with active tuberculosis.

OBJECTIVE: The ratio of monocytes to lymphocytes in peripheral blood could reflect an individual's immunity to Mycobacterium tuberculosis. The objective of this study was to evaluate the relationship between ratio of monocytes to lymphocytes and clinical status of patients with active tuberculosis. METHODS: This was a retrospective review of data collected from the clinical database of The Fifth People's Hospital of Wuxi, Medical College of Jiangnan University. A total of 419 patients who had newly diagnosed active tuberculosis and 108 cases from 419 patients with tuberculosis therapy either near completion or completed were selected. Controls were 327 healthy donors. RESULTS: Median ratio of monocytes to lymphocytes was 0.36 (IQR, 0.22-0.54) in patients before treatment, and 0.16 (IQR, 0.12-0.20) in controls (p<0.001). Ratio of monocytes to lymphocytes <9% or >25% was significant predictors for active tuberculosis (OR=114.73, 95% CI, 39.80-330.71; OR=89.81, 95% CI, 53.18-151.68, respectively). After treatment, the median ratio of monocytes to lymphocytes recovered to be nearly normal. Compared to other patients, patients with extrapulmonary tuberculosis and of age >60 years were more likely to have extreme ratio of monocytes to lymphocytes (AOR=2.57, 95% CI, 1.08-6.09; AOR=4.36, 95% CI, 1.43-13.29, respectively). CONCLUSIONS: Ratio of monocytes to lymphocytes <9% or >25% is predictive of active tuberculosis.

Prevalent tuberculosis at HIV diagnosis in Rio de Janeiro, Brazil: the TB/HIV in Rio (THRio) Cohort.

BACKGROUND: Although Brazil has model HIV care programs, many patients continue to present late to care. We studied the frequency of tuberculosis (TB) diagnosed at HIV diagnosis in Rio de Janeiro, Brazil, to quantify missed opportunities for TB prevention. METHODS: People living with HIV (PLHIV) and enrolled in the TB/HIV in Rio study between September 1, 2005, and August 31, 2009, were included. Prevalent TB was defined as TB diagnosed within 60 days of HIV diagnosis or HIV diagnosis during TB therapy. Survival was measured from HIV diagnosis. We conducted Kaplan-Meier survival plots and Cox regression analyses. RESULTS: Four thousand five hundred forty-eight newly diagnosed PLHIV were enrolled: 476 (10.5%) with prevalent TB. Individuals with prevalent TB were older, had lower CD4 counts, and higher viral loads than did those without TB. Median time to receiving highly active antiretroviral therapy (HAART) in those with prevalent TB was 99 days (interquartile range = 58-191) vs. 126 days (interquartile range = 63-301) in those without TB (P = 0.021). Among those with prevalent TB, 17% died during follow-up compared with 8% among those without TB (P < 0.001). After adjustment for sex, age, baseline CD4, and baseline viral load, the risk of occurrence of death remained significantly higher among those with prevalent TB [adjusted hazard ratio = 1.72 (confidence interval 95% 1.19 to 2.48)]. CONCLUSIONS: More than 10% of new PLHIV in our study presented to care with concurrent active TB disease and thus missed the opportunity for undergoing TB preventive therapy. Despite initiating HAART more quickly, these individuals were at a significantly greater risk of death. Earlier HIV diagnosis is necessary to provide earlier initiation of HAART and TB preventive therapy to reduce morbidity and mortality in PLHIV.

The effect of HIV-related immunosuppression on the risk of tuberculosis transmission to household contacts.

BACKGROUND: Coinfection with human immunodeficiency virus (HIV) may modify the risk of transmitting tuberculosis. Some previous investigations suggest that patients coinfected with HIV and tuberculosis are less likely to transmit infection, whereas others do not support this conclusion. Here, we estimated the relative risk of tuberculosis transmission from coinfected patients compared to HIV-negative patients with tuberculosis. METHODS: Between September 2009 and August 2012, we identified and enrolled 4841 household contacts of 1608 patients with drug-sensitive tuberculosis in Lima, Peru. We assessed the HIV status and CD4 counts of index patients, as well as other risk factors for infection specific to the index patient, the household, and the exposed individuals. Contacts underwent tuberculin skin testing to determine tuberculosis infection status. RESULTS: After adjusting for covariates, we found that household contacts of HIV-infected tuberculosis patients with a CD4 count ≤250 cells/µL were less likely to be infected with tuberculosis (risk ratio = 0.49 [95% confidence interval, .24-.96]) than the contacts of HIV-negative tuberculosis patients. No children younger than 15 years who were exposed to HIV-positive patients with a CD4 count ≤250 cells/µL were infected with tuberculosis, compared to 22% of those exposed to non-HIV-infected patients. There was no significant difference in the risk of infection between contacts of HIV-infected index patients with CD4 counts >250 cells/µL and contacts of index patients who were not HIV-infected. CONCLUSIONS: We found a reduced risk of tuberculosis infection among the household contacts of patients with active tuberculosis who had advanced HIV-related immunosuppression, suggesting reduced transmission from these index patients.

Duration of anti-tuberculosis therapy and timing of antiretroviral therapy initiation: association with mortality in HIV-related tuberculosis.

BACKGROUND: Antiretroviral therapy (ART) decreases mortality risk in HIV-infected tuberculosis patients, but the effect of the duration of anti-tuberculosis therapy and timing of anti-tuberculosis therapy initiation in relation to ART initiation on mortality, is unclear. METHODS: We conducted a retrospective observational multi-center cohort study among HIV-infected persons concomitantly treated with Rifamycin-based anti-tuberculosis therapy and ART in Latin America. The study population included persons for whom 6 months of anti-tuberculosis therapy is recommended. RESULTS: Of 253 patients who met inclusion criteria, median CD4+ lymphocyte count at ART initiation was 64 cells/mm(3), 171 (68%) received >180 days of anti-tuberculosis therapy, 168 (66%) initiated anti-tuberculosis therapy before ART, and 43 (17%) died. In a multivariate Cox proportional hazards model that adjusted for CD4+ lymphocytes and HIV-1 RNA, tuberculosis diagnosed after ART initiation was associated with an increased risk of death compared to tuberculosis diagnosis before ART initiation (HR 2.40; 95% CI 1.15, 5.02; P = 0.02). In a separate model among patients surviving >6 months after tuberculosis diagnosis, after adjusting for CD4+ lymphocytes, HIV-1 RNA, and timing of ART initiation relative to tuberculosis diagnosis, receipt of >6 months of anti-tuberculosis therapy was associated with a decreased risk of death (HR 0.23; 95% CI 0.08, 0.66; P=0.007). CONCLUSIONS: The increased risk of death among persons diagnosed with tuberculosis after ART initiation highlights the importance of screening for tuberculosis before ART initiation. The decreased risk of death among persons receiving > 6 months of anti-tuberculosis therapy suggests that current anti-tuberculosis treatment duration guidelines should be re-evaluated.

Factors associated with length of hospital stay among HIV positive and HIV negative patients with tuberculosis in Brazil.

OBJECTIVE: Identify and analyze the factors associated to length of hospital stay among HIV positive and HIV negative patients with tuberculosis in Manaus city, state of Amazonas, Brazil, in 2010. METHODS: Epidemiological study with primary data obtained from monitoring of hospitalized patients with tuberculosis in Manaus. Data were collected by interviewing patients and analyzing medical records, according to the following study variables age, sex, co-morbidities, education, race, income, lifestyle, history of previous treatment or hospitalization due to tuberculosis, treatment regimen, adverse reactions, smear test, clinical form, type of discharge, and length of hospital stay. The associated factors were identified through chi-square or t-Student test at a 5% significance level. RESULTS: Income from 1 to 3 minimum wages (P = 0.028), pulmonary tuberculosis form (P = 0.011), negative smear test or no information in this regard (P = 0.014), initial 6-month treatment scheme (P = 0.029), and adverse drug reactions (P = 0.021) were associated to prolonged hospital stay in HIV positive patients. CONCLUSION: We found out that although there were no significant differences in the length of hospital stay in HIV positive patients, all factors significantly associated to prolonged hospital stay occurred in this group of patients. This finding corroborates other studies indicating the severity of tuberculosis in HIV patients, which may also contribute to lengthen their hospital stay.

Community-based rapid oral human immunodeficiency virus testing for tuberculosis patients in Lima, Peru.

Among tuberculosis patients, timely diagnosis of human immunodeficiency virus (HIV) co-infection and early antiretroviral treatment are crucial, but are hampered by a myriad of individual and structural barriers. Community-based models to provide counseling and rapid HIV testing are few but offer promise. During November 2009-April 2010, community health workers offered and performed HIV counseling and testing by using the OraQuick Rapid HIV-1/2 Antibody Test to new tuberculosis cases in 22 Ministry of Health establishments and their household contacts (n = 130) in Lima, Peru. Refusal of HIV testing or study participation was low (4.7%). Intervention strengths included community-based approach with participant preference for testing site, use of a rapid, non-invasive test, and accompaniment to facilitate HIV care and family disclosure. We will expand the intervention under programmatic auspices for rapid community-based testing for new tuberculosis cases in high incidence establishments. Other potential target populations include contacts of HIV-positive persons and pregnant women.

Microscopic observation drug susceptibility assay for tuberculosis screening before isoniazid preventive therapy in HIV-infected persons.

BACKGROUND: Active tuberculosis (TB) must be excluded before initiating isoniazid preventive therapy (IPT) in persons infected with human immunodeficiency virus (HIV), but currently used screening strategies have poor sensitivity and specificity and high patient attrition rates. Liquid TB culture is now recommended for the detection of Mycobacterium tuberculosis in individuals suspected of having TB. This study compared the efficacy, effectiveness, and speed of the microscopic observation drug susceptibility (MODS) assay with currently used strategies for TB screening before IPT in HIV-infected persons. METHODS: A total of 471 HIV-infected IPT candidates at 3 hospitals in Lima, Peru, were enrolled in a prospective comparison of TB screening strategies, including laboratory, clinical, and radiographic assessments. RESULTS: Of 435 patients who provided 2 sputum samples, M. tuberculosis was detected in 27 (6.2%) by MODS culture, 22 (5.1%) by Lowenstein-Jensen culture, and 7 (1.6%) by smear. Of patients with any positive microbiological test result, a MODS culture was positive in 96% by 14 days and 100% by 21 days. The MODS culture simultaneously detected multidrug-resistant TB in 2 patients. Screening strategies involving combinations of clinical assessment, chest radiograph, and sputum smear were less effective than 2 liquid TB cultures in accurately diagnosing and excluding TB (P<.01). Screening strategies that included nonculture tests had poor sensitivity and specificity. CONCLUSIONS: MODS culture identified and reliably excluded cases of pulmonary TB more accurately than other screening strategies, while providing results significantly faster than Lowenstein-Jensen culture. Streamlining of the ruling out of TB through the use of liquid culture-based strategies could help facilitate the massive up-scaling of IPT required to reduce HIV and TB morbidity and mortality.

AIDS-related tuberculosis in Rio de Janeiro, Brazil.

BACKGROUND: We studied the incidence of tuberculosis, AIDS, AIDS deaths and AIDS-TB co-infection at the population level in Rio de Janeiro, Brazil where universal and free access to combination antiretroviral therapy has been available since 1997. METHODOLOGY/PRINCIPAL FINDINGS: This was a retrospective surveillance database match of Rio de Janeiro databases from 1995-2004. Proportions of tuberculosis occurring within 30 days and between 30 days and 1 year after AIDS diagnosis were determined. Generalized additive models fitted with cubic splines with appropriate estimating methods were used to describe rates and proportions over time. Overall, 90,806 tuberculosis cases and 16,891 AIDS cases were reported; 3,125 tuberculosis cases within 1 year of AIDS diagnosis were detected. Tuberculosis notification rates decreased after 1997 from a fitted rate (fR per 100,000) of 166.5 to 138.8 in 2004. AIDS incidence rates increased 26% between 1995 and 1998 (30.7 to 38.7) followed by a 33.3% decrease to 25.8 in 2004. AIDS mortality rates decreased dramatically after antiretroviral therapy was introduced between 1995 (27.5) and 1999 (13.4). The fitted proportion (fP) of patients with tuberculosis diagnosed within one year of AIDS decreased from 1995 (24.4%) to 1998 (15.2%), remaining stable since. Seventy-five percent of tuberculosis diagnoses after an AIDS diagnosis occurred within 30 days of AIDS diagnosis. CONCLUSIONS/SIGNIFICANCE: Our results suggest that while combination ART should be considered an essential component of the response to the HIV and HIV/tuberculosis epidemics, it may not be sufficient alone to prevent progression from latent TB to active disease among HIV-infected populations. When tuberculosis is diagnosed prior to or at the same time as AIDS and ART has not yet been initiated, then ART is ineffective as a tuberculosis prevention strategy for these patients. Earlier HIV/AIDS diagnosis and ART initiation may reduce TB incidence in HIV/AIDS patients. More specific interventions will be required if HIV-related tuberculosis incidence is to continue to decline.

Avaliação do papel do interferon-y na modulação da resposta tecidual durante a infecção pelo Mycobacterium bovis / Evaluation of the role of interferon-y in the modulation of tissue response during infection with Mycobacterium bovis

O IFN-y tem sido implicado na defesa do hospedeiro contra as micobactérias. Esta citocina, produzida e liberada por linfócitos T recrutados para o sítio da infecção, é considerada o agente chave da ativação endógena, promovendo efeitos antimicobacterianos de macrófagos. Diversos modelos experimentais têm sido desenvolvidos para delinear o papel de citocinas responsáveis pelo controle da tuberculose. O presente estudo visa delinear o papel do IFN-y na modulação da resposta inflamatória granulomatosa no tecido hepático e pulmonar em camundongos infectados experimentalmente com o M. bovis. Os experimentos foram realizados utilizando-se camundongos com deficiência do gene responsável pela produção do IFN-y (C57BL/6 IFN-y-l-) e camundongos que produzem IFN-y (C57BL/6 IFN-y+l+), ambos infectados por via intravenosa com M. bovis. Avaliou-se a capacidade de sobrevida e multiplicação do M. bovis no fígado e pulmões, assim como características histopatógicas nestes dois órgãos. No curso da infecção (15, 30, 50 e 100 dias pós-infecção) a CFU (unidade formadora de colônia) foi quantificada no tecido hepático e pulmonar dos dois grupos de camundongos. A carga bacilar dos animais IFN-y-l- foi significantemente maior que nos IFN-y+/+. A quantidade de CFU foi maior no fígado que nos pulmões dos animais IFN-y-l- durante todo o estudo, enquanto nos IFN-y+/+ apenas no primeiro ponto estudado (15 dias pós-infecção). Adicionalmente, nos camundongos IFN-y/- ocorreu um aumento contínuo da carga bacilar com o transcurso da infecção, enquanto os camundongos IFN-y+/+ foram capazes de reduzir a carga bacilar no tecido hepático nos períodos mais tardios da análise. As alteraíões histopatológicas começam mais tardiamente nos camundongos IFN-y-/- (30 dias de pós-infecção). Estes formam granulomas sempre em menor número e tamanho que os IFN-y+/+. As alterações granulomatosas no fígado persistem até os 100 dias no camundongo IFN-y-l- e diminuem nos IFN-y+/+. Portanto, a presença do...

Serological screening for tuberculosis in the community: an evaluation of the Mycodot procedure in an African population with high HIV-2 prevalence (Republic of Guinea-Bissau)

The immuno-dot-blot assay MycoDot, which detects lipoarabinomannan (LAM) antibodies, was evaluated for the serological diagnosis of active pulmonary tuberculosis in patients in a rural community in the Republic of Guinea-Bissau. Sera from 269 adults (age > 15) and 33 children (age < 5) were assayed for antibodies in a blind manner and the results compared to the clinical status of tuberculosis. The assay had a specificity and a sensitivity of 92.4 per cent and 63.0 per cent respectively, when applied to the adult population. In HIV-2 infected individuals (27/269), the specificity and sensitivity of the assay were similar, 94.7 per cent and 62.5 per cent respectively. The assay did not provide high sensitivity for the diagnosis of tuberculosis in children. Sera from patients with leprosy cross-reacted with the antigen of the assay. It is concluded that this easily performed assay may be useful for the presumptive diagnosis of tuberculosis in adult populations in rural areas of developing countries where routine screening is not readily available.

Treatment of tuberculosis in a rural area of Haiti: directly observed and non-observed regimens. The experience of H pital Albert Schweitzer.

SETTING: Artibonite Valley, a rural area in Haiti. OBJECTIVE: To evaluate a tuberculosis control program in rural Haiti and to compare two strategies for treatment implemented in two areas that were not chosen at random: treatment delivered at the patients' homes observed by former tuberculosis patients (DOT), and non observed treatment (non-DOT). DESIGN: Retrospective analysis of the clinical records of adult patients diagnosed with tuberculosis at H pital Albert Schweitzer in Deschapelles, Haiti, during 1994-1995. RESULTS: There were 143 patients in the non-DOT group and 138 patients in the DOT group. The results of treatment were significantly different: in the non-DOT group 29% defaulted, 12% died and 58% had a successful outcome; in the DOT group 7% defaulted (P < 0.01), 4% died (P = 0.01) and 87% had a successful outcome (P < 0.01). These differences are also significant when considering only human immunodeficiency virus (HIV) infected patients (defaulted P < 0.01; died P = 0.09; successful outcome P < 0.01). CONCLUSION: Delivering treatment in patients' homes with direct observation by former tuberculosis patients can achieve good results, even in an area of extreme poverty and high rates of HIV infection. In this population the number of patients who are able to complete their treatment without observed administration is far from optimal.

A study of the Knowledge, attitudes and practices of primary health care workers in the South-East region of Jamaica concerning the DOTS strategy for the control of tuberculosis

Tuberculosis is an infectious disease caused by the micro-organism Mycobacterium tuberculosis. This micro-organism can be found in about one third of the world population and causes more deaths than any other infectious agent globally. To control this deadly disease, persons ill witH TB need to take a combination of medications for a period of 6 to 8 months. Most of those suffering from TB find this difficult, and to aid in the adequate treatment of persons with the disease and protect others from it, the World Health Organisation along with others concerned about the situation, developed the directly observed treatment, short-course (DOTS) strategy. This cost effective method of treatment requires that health workers world wide observe infected persons while they take their tablets. The aim of this study was to assess the knowledge, attitudes and practices of primary health care workers about the treatment and control of TB using the directly observed treatment, short-course (DOTS) strategy. Data were collected using a questionnaire administered to a sample of selected categories of health workers in the study area. Additionally, three selected key informants from the Jamaican health services were interviewed. One hundred and seventy respondents from five categories, (medical officers, nurses, public health inspectors, community health aids and contact investigators) completed questionnaires. The study found that primary health care workers in Jamaica are very willing to participate in this global effort. They feel confident that once they are given the right tools to work with they can contribute ... The study recommends a review of the progress of the implementation program, preparation of a revised plan of action will all involved in TB control activities and institution of training programs throughout the health service on this "health breakthrough of the 1990's" (AU)

Risk behaviors, HIV seropositivity, and tuberculosis infection in injecting drug users who operate shooting galleries in Puerto Rico.

This study was designed to assess HIV risk behaviors, HIV seroprevalence, and tuberculosis (TB) infection in shooting gallery managers in Puerto Rico. The subjects were 464 injection drug users (IDUs), of whom 12.5% reported managing shooting galleries. The median frequency of drug injection was higher in shooting gallery managers than in nonmanagers. A trend was observed for purified protein derivative (PPD) reactivity to increase according to the length of time spent as a gallery manager, but this trend was not statistically significant. However, anergy rates increased significantly with increase in the number of months spent as shooting gallery manager (p = .021). Multivariate analyses showed that IDUs reporting shooting gallery management experience of > or = 25 months were more likely to be infected with HIV. Prevention programs need to emphasize strategies to protect the health of shooting gallery clients and, in particular, shooting gallery managers. Additional studies are required to determine effective strategies for reducing the risk of HIV and TB infection in shooting galleries.

PIP: Little information is currently available on the health status of individuals who manage the settings in which drug injection-related behaviors occur. The present study investigated HIV risk behaviors, HIV seroprevalence, and tuberculosis infection among 464 injecting drug users recruited from areas in San Juan, Puerto Rico, known to have high levels of drug activity. 58 respondents (12.5%) reported having been a shooting gallery manager, for a median duration of 18 months. Managers were more likely to be female, over 35 years of age, not married, homeless, to inject only cocaine, to inject more frequently, to have a history of incarceration, and to report disability than drug users who were not managers. No differences in rates of HIV, tuberculosis, or anergy existed between managers with 1-24 months of management experience and nonmanagers. However, gallery managers with 25 or more months of experience were nearly 3 times more likely to be infected with HIV, nearly 2 times more likely to be anergic, and 2.5 times more likely to have tuberculosis than nonmanagers. 41% of nonmanagers, 48% of managers with 1-24 months of experience, and 71% of those who had been managers for 25 months or more were HIV-seropositive. The compromised health status of long-term shooting gallery managers underscores the need for public health interventions to interrupt the spread of sexually transmitted diseases, HIV, and tuberculosis in this high-risk setting.