Optimal Management of Drug-Resistant Tuberculosis and Human Immunodeficiency Virus: an Update

2018 ◽  
Vol 10 (1) ◽  
pp. 90-106
Author(s):  
Anja Reuter ◽  
Jennifer Furin
Keyword(s):  
Human Immunodeficiency Virus ◽  
Drug Resistant ◽  
Optimal Management ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Immunodeficiency Virus

Mycobacterium tuberculosis in persons infected with the human immunodeficiency virus

1994 ◽  
Vol 3 (5) ◽  
pp. 389-397 ◽  
Author(s):  
Co MCJr
Keyword(s):  
Human Immunodeficiency Virus ◽  
Mycobacterium Tuberculosis ◽  
Latent Tuberculosis ◽  
Public Health Problem ◽  
The United States ◽  
Major Public Health Problem ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Immunodeficiency Virus

BACKGROUND: After decades of decreasing incidence, the number of new tuberculosis cases started to rise again in the mid-1980s and continues to be a major public health problem in the United States. The incidence of tuberculosis and drug-resistant tuberculosis is increasing among persons infected with human immunodeficiency virus. OBJECTIVE: To review the epidemiology, pathogenesis, clinical presentation, diagnosis, drug therapy, patients' nonadherence to prescribed treatment, and nursing issues related to the care of persons dually infected with tuberculosis and human immunodeficiency virus. METHODS: Fifty references addressing important issues in tuberculosis and human immunodeficiency virus were identified by searching the Medline data base and bibliographies of relevant articles. DISCUSSION: Tuberculosis is a communicable infectious disease caused by Mycobacterium tuberculosis. It is curable and preventable but generally fatal if undiagnosed and untreated. People with human immunodeficiency virus infection are at higher risk for reactivation of latent tuberculosis infection and for developing life-threatening tuberculosis. Specific nursing interventions are formulated to guide practice when caring for HIV-infected persons with tuberculosis. Future nursing research needs are suggested. CONCLUSIONS: An understanding of the complexity of the care involved will enhance the clinical management of tuberculosis in human immunodeficiency virus-infected patients and lead to a decline in the appearance of new drug-resistant tuberculosis strains.

scholarly journals The effect of human immunodeficiency virus infection on adverse events during treatment of drug-resistant tuberculosis: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248017
Author(s):  
Gilbert Lazarus ◽  
Kevin Tjoa ◽  
Anthony William Brian Iskandar ◽  
Melva Louisa ◽  
Evans L. Sagwa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Human Immunodeficiency Virus ◽  
Adverse Events ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Immunodeficiency Virus

Background Adverse events (AEs) during drug-resistant tuberculosis (DR-TB) treatment, especially with human immunodeficiency virus (HIV) co-infection, remains a major threat to poor DR-TB treatment adherence and outcomes. This meta-analysis aims to investigate the effect of HIV infection on the development of AEs during DR-TB treatment. Methods Eligible studies evaluating the association between HIV seropositivity and risks of AE occurrence in DR-TB patients were included in this systematic review. Interventional and observational studies were assessed for risk of bias using the Risk of Bias in Nonrandomized Studies of Intervention and Newcastle-Ottawa Scale tool, respectively. Random-effects meta-analysis was performed to estimate the pooled risk ratio (RR) along with their 95% confidence intervals (CIs). Results A total of 37 studies involving 8657 patients were included in this systematic review. We discovered that HIV infection independently increased the risk of developing AEs in DR-TB patients by 12% (RR 1.12 [95% CI: 1.02–1.22]; I2 = 0%, p = 0.75). In particular, the risks were more accentuated in the development of hearing loss (RR 1.44 [95% CI: 1.18–1.75]; I2 = 60%), nephrotoxicity (RR 2.45 [95% CI: 1.20–4.98], I2 = 0%), and depression (RR 3.53 [95% CI: 1.38–9.03]; I2 = 0%). Although our findings indicated that the augmented risk was primarily driven by antiretroviral drug usage rather than HIV-related immunosuppression, further studies investigating their independent effects are required to confirm our findings. Conclusion HIV co-infection independently increased the risk of developing AEs during DR-TB treatment. Increased pharmacovigilance through routine assessments of audiological, renal, and mental functions are strongly encouraged to enable prompt diagnosis and treatment in patients experiencing AEs during concomitant DR-TB and HIV treatment.

scholarly journals Functional Adrenal Insufficiency among Tuberculosis-Human Immunodeficiency Virus co-infected patients: A Cross-section study in Uganda

2019 ◽  
Author(s):  
Agnes Bwanika Bwanika Naggirinya ◽  
Irene Andia Biraro ◽  
David B. Meya ◽  
Ezekiel Mupere ◽  
Andrew Mujugira ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Adrenal Insufficiency ◽  
Serum Cortisol ◽  
Early Morning ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Immunodeficiency Virus ◽  
Morning Serum Cortisol

Abstract Objective:Tuberculosis is the leading cause of adrenal insufficiency in resource-limited settings. The adrenal gland is the most commonly affected endocrine organ in tuberculosis infection. We assessed prevalence and factors associated with functional adrenal insufficiency among human immunodeficiency virus infected patients with multidrug-resistant and drug-susceptible tuberculosis in Uganda. Patients with drug-sensitive and resistant tuberculosis were enrolled, examined for clinical signs and symptoms of adrenal insufficiency, an early morning serum cortisol level obtained. Functional adrenal insufficiency was defined as early morning serum cortisol below 414/nmol//L. Associations with functional adrenal insufficiency were estimated using multivariable logistic regression.ResultsA total of 311 tuberculosis patients were screened, and 272 enrolled. Of these, 117 (43%) had multi-drug resistant tuberculosis. Median age was 32 years (IQR 18-66) and 66% were men. Prevalence of functional adrenal insufficiency was 59.8%. Mean cortisol levels were lower in participants with multi-drug resistant than drug-susceptible tuberculosis (317.4 versus 488.5 nmol/L; p<0.001). In multivariable analysis, multi-drug resistant tuberculosis (aOR 36.60; 95% CI 8.30-161.42; p<0.001) and skin hyperpigmentation (aOR 9.63; 95% CI: 2.83-32.8; p<0.001) were significantly associated with functional adrenal insufficiency. Early morning serum cortisol levels should be quantified in TB-HIV co-infected patients.

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