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Harries AD, Lin Y, Thekkur P, Nair D, Chakaya J, Dongo JP, Luzze H, Chimzizi R, Mubanga A, Timire C, Kavenga F, Satyanarayana S, Kumar AMV, Khogali M, Zachariah R. Why TB programmes should assess for comorbidities, determinants and disability at the start and end of TB treatment. Int J Tuberc Lung Dis 2023; 27:495-498. [PMID: 37353872 DOI: 10.5588/ijtld.23.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Y Lin
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P Thekkur
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - D Nair
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - J Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya, Respiratory Society of Kenya, Nairobi, Kenya
| | - J P Dongo
- The Union-Uganda Office, Kampala, Uganda
| | - H Luzze
- National Leprosy and Tuberculosis Programme, Ministry of Health, Kampala, Uganda
| | - R Chimzizi
- Ministry of Health/USAID STAR Project, Lusaka, Zambia
| | - A Mubanga
- National Tuberculosis Programme, Ministry of Health, Lusaka, Zambia
| | - C Timire
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK, Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - F Kavenga
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India
| | - M Khogali
- Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - R Zachariah
- Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
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Sekandi JN, List J, Luzze H, Yin XP, Dobbin K, Corso PS, Oloya J, Okwera A, Whalen CC. Yield of undetected tuberculosis and human immunodeficiency virus coinfection from active case finding in urban Uganda. Int J Tuberc Lung Dis 2014; 18:13-9. [PMID: 24365547 DOI: 10.5588/ijtld.13.0129] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To determine the yield of undetected active tuberculosis (TB), TB and human immunodeficiency virus (HIV) coinfection and the number needed to screen (NNS) to detect a case using active case finding (ACF) in an urban community in Kampala, Uganda. METHODS In a door-to-door survey conducted in Rubaga community from January 2008 to June 2009, residents aged ≥15 years were screened for chronic cough (≥2 weeks) and tested for TB disease using smear microscopy and/or culture. Rapid testing was used to screen for HIV infection. The NNS to detect one case was calculated based on population screened and undetected cases found. RESULTS Of 5102 participants, 3868 (75.8%) were females; the median age was 24 years (IQR 20-30). Of 199 (4%) with chronic cough, 160 (80.4%) submitted sputum, of whom 39 (24.4%, 95%CI 17.4-31.5) had undetected active TB and 13 (8.1%, 95%CI 6.7-22.9) were TB-HIV co-infected. The NNS to detect one TB case was 131 in the whole study population, but only five among the subgroup with chronic cough. CONCLUSION ACF obtained a high yield of previously undetected active TB and TB-HIV cases. The NNS in the general population was 131, but the number needed to test in persons with chronic cough was five. These findings suggest that boosting the identification of persons with chronic cough may increase the overall efficiency of TB case detection at a community level.
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Affiliation(s)
- J N Sekandi
- College of Public Health, University of Georgia, Athens, Georgia, USA; and School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - J List
- Yale Primary Care Program, Yale University School of Medicine, New Haven, Connecticut, USA
| | - H Luzze
- Department of Clinical Services, Ministry of Health, Kampala, Uganda
| | - X-P Yin
- College of Public Health, University of Georgia, Athens, Georgia, USA
| | - K Dobbin
- College of Public Health, University of Georgia, Athens, Georgia, USA
| | - P S Corso
- College of Public Health, University of Georgia, Athens, Georgia, USA
| | - J Oloya
- College of Public Health, University of Georgia, Athens, Georgia, USA
| | - A Okwera
- National TB Treatment Center, School of Medicine, Makerere University, Mulago, Uganda
| | - C C Whalen
- College of Public Health, University of Georgia, Athens, Georgia, USA
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Sekandi JN, List J, Luzze H, Yin X, Dobbin K, Corso PS, Oloya J, Okwera A, Whalen CC. In reply to 'Active case finding for tuberculosis: what is the most informative measure for policy makers?'. Int J Tuberc Lung Dis 2014; 18:377-8. [PMID: 24670580 DOI: 10.5588/ijtld.13.0924-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- J N Sekandi
- College of Public Health, University of Georgia, Athens, Georgia, USA; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - J List
- Yale Primary Care Program, Yale University School of Medicine, New Haven, Connecticut, USA
| | - H Luzze
- Department of Clinical Services, Ministry of Health, Kampala, Uganda
| | - X Yin
- College of Public Health, University of Georgia, Athens, Georgia, USA
| | - K Dobbin
- College of Public Health, University of Georgia, Athens, Georgia, USA
| | - P S Corso
- College of Public Health, University of Georgia, Athens, Georgia, USA
| | - J Oloya
- College of Public Health, University of Georgia, Athens, Georgia, USA
| | - A Okwera
- National TB Treatment Center, School of Medicine, Makerere University, Mulago, Uganda
| | - C C Whalen
- College of Public Health, University of Georgia, Athens, Georgia, USA
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Luzze H, Johnson DF, Dickman K, Mayanja-Kizza H, Okwera A, Eisenach K, Cave MD, Whalen CC, Johnson JL, Boom WH, Joloba M. Relapse more common than reinfection in recurrent tuberculosis 1-2 years post treatment in urban Uganda. Int J Tuberc Lung Dis 2013; 17:361-7. [PMID: 23407224 DOI: 10.5588/ijtld.11.0692] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine the proportion of recurrent tuberculosis (TB) due to relapse with the patient's initial strain or reinfection with a new strain of Mycobacterium tuberculosis 1-2 years after anti-tuberculosis treatment in Uganda, a sub-Saharan TB-endemic country. DESIGN Records of patients with culture-confirmed TB who completed treatment at an urban Ugandan clinic were reviewed. Restriction fragment length polymorphism (RFLP) patterns were used to determine relapse or reinfection. Associations between human immunodeficiency virus (HIV) positivity and type of TB recurrence were determined. RESULTS Of 1701 patients cured of their initial TB episode with a median follow-up of 1.24 years, 171 (10%) had TB recurrence (8.4 per 100 person-years). Rate and risk factors for recurrence were similar to other studies from sub-Saharan Africa. Insertion sequence (IS) 6110-based RFLP of paired isolates from 98 recurrences identified 80 relapses and 18 reinfections. Relapses among HIV-positive and -negative patients were respectively 79% and 85% of recurrences. CONCLUSIONS Relapse was more common and presented earlier than reinfection in both HIV-positive and -negative TB patients 1-2 years after completing treatment. These findings impact both the choice of retreatment drug regimen, as relapsing patients are at higher risk for acquired drug resistance, and clinical trials of new TB regimens with relapse as clinical endpoint.
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Affiliation(s)
- H Luzze
- National Tuberculosis and Leprosy Program, Mulago Hospital and Complex, Kampala, Uganda
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Mayanja-Kizza H, Wu M, Aung H, Liu S, Luzze H, Hirsch C, Toossi Z. The Interaction of Monocyte Chemoattractant Protein-1 and Tumour Necrosis Factor-α inMycobacterium tuberculosis-induced HIV-1 Replication at Sites of Active Tuberculosis. Scand J Immunol 2009; 69:516-20. [DOI: 10.1111/j.1365-3083.2009.02246.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Srikantiah P, Lin R, Walusimbi M, Okwera A, Luzze H, Whalen CC, Boom WH, Havlir DV, Charlebois ED. Elevated HIV seroprevalence and risk behavior among Ugandan TB suspects: implications for HIV testing and prevention. Int J Tuberc Lung Dis 2007; 11:168-74. [PMID: 17263287 PMCID: PMC2846511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES Voluntary counseling and testing (VCT) for the human immunodeficiency virus (HIV) is recommended for persons treated for tuberculosis (TB). Opportunities to diagnose HIV may be missed by limiting HIV testing to only persons diagnosed with TB. Among TB suspects in Uganda, we determined HIV prevalence, risk behaviors, and willingness to refer family for VCT. METHODS Consenting adult patients presenting for evaluation at a referral TB clinic received same-day VCT. TB diagnosis data were abstracted from clinical records. RESULTS Among 665 eligible patients, 565 (85%) consented to VCT. Among these, 238 (42%) were HIV-positive. Of the HIV-infected patients, 37% had received a non-TB diagnosis. HIV seroprevalence was higher in patients with a non-TB diagnosis (49%) than those diagnosed with TB (39%) (P = 0.02). Fewer than 6% of HIV-infected patients reported always using condoms with sexual partners. The majority of patients (86%) reported being 'very willing' to refer family members for VCT. CONCLUSIONS Over 35% of HIV-infected cases in our population would have been undetected if HIV testing was limited to cases with diagnosed TB. The high HIV seroprevalence in both TB and non-TB cases merits HIV testing for all patients evaluated at TB clinics. HIV-infected TB suspects reporting high-risk behavior are at risk for HIV transmission, and should receive risk-reduction counseling.
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Affiliation(s)
- P Srikantiah
- Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco 94110, USA.
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Okwera A, Johnson JL, Luzze H, Nsubuga P, Kayanja H, Cohn DL, Nunn P, Ellner JJ, Whalen CC, Mugerwa RD. Comparison of intermittent ethambutol with rifampicin-based regimens in HIV-infected adults with PTB, Kampala. Int J Tuberc Lung Dis 2006; 10:39-44. [PMID: 16466035 PMCID: PMC2869085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The human immunodeficiency virus (HIV) is a key factor responsible for the high rates of tuberculosis (TB) in sub-Saharan Africa. Treatment of TB with rifampicin (R, RMP) containing short-course regimens is highly effective in HIV-infected adults. We conducted a study to compare the efficacy and safety of intermittent ethambutol (E, EMB) with two RMP-containing regimens to treat pulmonary TB in HIV-infected patients. SETTING National Tuberculosis Treatment Centre, Mulago Hospital, Kampala, Uganda. DESIGN This was a prospective cohort compared to two non-randomised control groups. The study group and the two control arms were treated with 2 months of isoniazid (H), RMP, pyrazinamide (Z) and EMB followed by 6 E3H3 for the study group and 4HR or 6HR for controls. RESULTS Between April 1993 and March 2000, 136 patients were enrolled in the 2EHRZ/E3H3 arm, 147 in the 2EHRZ/4HR arm and 266 in the 2EHRZ/6HR arm. The relapse rate was 18.2 per 100 person-years observation (PYO) for the study regimen compared to 9.7/100 PYO (P = 0.0063) and 4.8/100 PYO (P = 0.0001) in patients treated with 2 EHRZ/4HR or 2EHRZ/6HR, respectively. CONCLUSION The 2EHRZ/6E3H3 regimen is safe and effective but has a significant risk of relapse.
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Affiliation(s)
- A Okwera
- National Tuberculosis and Leprosy Programme, Kampala, Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda.
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Toossi Z, Johnson JL, Kanost RA, Wu M, Luzze H, Peters P, Okwera A, Joloba M, Mugyenyi P, Mugerwa RD, Aung H, Ellner JJ, Hirsch CS. Increased replication of HIV-1 at sites of Mycobacterium tuberculosis infection: potential mechanisms of viral activation. J Acquir Immune Defic Syndr 2001; 28:1-8. [PMID: 11579270 DOI: 10.1097/00042560-200109010-00001] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tuberculosis (TB) enhances HIV-1 replication and the progression to AIDS in dually infected patients. We employed pleural TB as a model to understand the interaction of the host with HIV-1 during active TB, at sites of Mycobacterium tuberculosis (MTB) infection. HIV-1 replication was enhanced both in the cellular (pleural compared with blood mononuclear cells) and acellular (pleural fluid compared with plasma) compartments of the pleural space. Several potential mechanisms for expansion of HIV-1 in situ were found, including augmentation in expression of tumor necrosis factor (TNF)-alpha and the HIV-1 noninhibitory beta-chemokine (MCP-1), low presence of HIV-1 inhibitory beta-chemokines (MIP-1 alpha, MIP-1 beta, and RANTES [regulated on activation, normal T expressed and secreted]), and upregulation in expression of the HIV-1 coreceptor, CCR5, by pleural fluid mononuclear cells. Thus, at sites of MTB infection, conditions are propitious both for transcriptional activation of HIV-1 in latently infected mononuclear cells, and facilitation of viral infection of newly recruited cells. These mechanisms may contribute to enhanced viral burden and dissemination during TB infection.
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Affiliation(s)
- Z Toossi
- Department of Medicine, Case Western Reserve University, University Hospitals of Cleveland and Veterans Administration Medical Center, Cleveland, Ohio, USA.
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Luzze H, Elliott AM, Joloba ML, Odida M, Oweka-Onyee J, Nakiyingi J, Quigley M, Hirsch C, Mugerwa RD, Okwera A, Johnson JL. Evaluation of suspected tuberculous pleurisy: clinical and diagnostic findings in HIV-1-positive and HIV-negative adults in Uganda. Int J Tuberc Lung Dis 2001; 5:746-53. [PMID: 11495266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
SETTING National Tuberculosis Treatment Centre, Mulago Hospital, Kampala, Uganda. OBJECTIVES To compare clinical and radiographic presentation, and diagnostic methods, in adults with tuberculous pleurisy who are negative and positive for the human immunodeficiency virus (HIV). DESIGN Adults with suspected pleural tuberculosis were screened by clinical examination, thoracocentesis and closed pleural biopsy. Biopsy material was cultured on Middlebrook 7H-10 solid medium and in BACTEC 12B radiometric vials. Pleural fluid was cultured using Löwenstein-Jensen slants, BACTEC and Kirchner liquid medium. RESULTS Of 156 individuals enrolled, 142 had tuberculosis, of whom 80% were HIV-positive. Among those with tuberculosis, HIV-positive patients bad a more severe and longer illness. The size of effusions was similar in HIV-positive and HIV-negative patients. A higher proportion of HIV-positive patients had parenchymal infiltrates but this difference was not statistically significant. Pleural fluid lymphocytosis was present in all HIV-negative and 97% of the HIV-positive patients. HIV-positive patients had lower pleural fluid lymphocyte counts. Pleural fluid cultures were more often positive in HIV-positive patients. BACTEC and Kirchner liquid media gave higher yields than solid media. CONCLUSION HIV-positive patients with tuberculous pleurisy had a more severe illness than HIV-negative patients. Mycobacterial cultures from HIV-positive patients were more often positive, suggesting more mycobacterial extension from the lungs into the pleural space. Liquid culture media were superior to solid media with regard to diagnostic yield and time until diagnosis.
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Affiliation(s)
- H Luzze
- National Tuberculosis Treatment Centre, and Uganda-Case Western Reserve University Research Collaboration, Mulago Hospital, Kampala.
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Mayanja-Kizza H, Johnson JL, Hirsch CS, Peters P, Surewicz K, Wu M, Nalugwa G, Mubiru F, Luzze H, Wajja A, Aung H, Ellner JJ, Whalen C, Toossi Z. Macrophage‐Activating Cytokines in Human Immununodeficiency Virus Type 1–Infected and –Uninfected Patients with Pulmonary Tuberculosis. J Infect Dis 2001; 183:1805-9. [PMID: 11372035 DOI: 10.1086/320725] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2000] [Revised: 03/09/2001] [Indexed: 11/03/2022] Open
Abstract
Tuberculosis (TB) is the most common opportunistic infection in human immunodeficiency virus type 1 (HIV-1)-infected patients globally and occurs throughout the course of HIV-1 disease. Here the production of interferon (IFN)-gamma and tumor necrosis factor (TNF)-alpha by peripheral blood mononuclear cells (PBMC) of HIV-1-infected versus -uninfected patients with newly diagnosed pulmonary TB (PTB) was compared. Findings were correlated with cytokine profiles, clinical presentation, and expression of inducible nitric oxide (iNOS). Most HIV-1/PTB patients with a CD4 cell count of 200-500 cells/microL had high IFN-gamma production and radiographic evidence of atypical PTB. Low IFN-gamma production and radiographic evidence of reactivated PTB characterized both HIV-1/PTB patients with a CD4 cell count >or=500 cells/microL and HIV-1-uninfected patients. TNF-alpha levels were similar in all HIV-1/PTB patients, regardless of CD4 cell count. Induction of iNOS in PBMC was low and was associated with low IFN-gamma production. These data underscore the potential pathogenic role of macrophage-activating cytokines in TB in HIV-1-infected patients.
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Affiliation(s)
- H Mayanja-Kizza
- Department of Internal Medicine, Makerere University Medical School, Kampala, Uganda
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Hodsdon WS, Luzze H, Hurst TJ, Quigley MA, Kyosiimire J, Namujju PB, Johnson JL, Kaleebu P, Okwera A, Elliott AM. HIV-1-related pleural tuberculosis: elevated production of IFN-gamma, but failure of immunity to Mycobacterium tuberculosis. AIDS 2001; 15:467-75. [PMID: 11242143 DOI: 10.1097/00002030-200103090-00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Pleural tuberculosis can resolve spontaneously, suggesting that the inflammatory process may represent a protective immune response. However, pleural tuberculosis is strongly associated with HIV infection. It has been suggested that cell-mediated immune responses may be reduced, and direct bacterial invasion may have a role in pathogenesis, in HIV-positive cases. To test this hypothesis, we compared production of the pro-inflammatory cytokines, interferon (IFN)-gamma and tumour necrosis factor(TNF)-alpha, production of the immunosuppressive cytokine, interleukin (IL)-10, and mycobacterial culture positivity, in HIV-negative and HIV-positive patients with pleural tuberculosis. METHODS Cytokine levels were measured in serum and pleural fluid, and in supernatants of blood and pleural fluid stimulated in vitro using mycobacterial antigens. Intracellular IFN-gamma and TNF-alpha production was measured after stimulation with phorbol myristate acetate and ionomycin in vitro. RESULTS IFN-gamma was strikingly elevated in serum and pleural fluid in HIV-positive, compared to HIV-negative subjects (P < or = 0.02). TNF-alpha was elevated, but this was not statistically significant. IL-10 levels were higher in serum (P < 0.001), but similar in pleural fluid. IFN-gamma responses to soluble mycobacterial antigen in vitro were reduced in peripheral blood (P = 0.006), but not pleural fluid, of HIV-positive subjects. Intracellular cytokine staining suggested that CD8+ T cells were a major source of IFN-gamma in HIV-positive subjects. The proportion of subjects with a positive culture for Mycobacterium tuberculosis from pleural fluid was higher in the HIV-positive group. CONCLUSIONS HIV-positive patients with pleural tuberculosis show elevated production of IFN-gamma, for which CD8+ T cells may be a major source. Mycobacterium tuberculosis can proliferate despite high levels of pro-inflammatory cytokines.
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Affiliation(s)
- W S Hodsdon
- Medical Research Council Programme on AIDS, Uganda Virus Research Institute, Entebbe, Uganda
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Hirsch CS, Toossi Z, Johnson JL, Luzze H, Ntambi L, Peters P, McHugh M, Okwera A, Joloba M, Mugyenyi P, Mugerwa RD, Terebuh P, Ellner JJ. Augmentation of apoptosis and interferon-gamma production at sites of active Mycobacterium tuberculosis infection in human tuberculosis. J Infect Dis 2001; 183:779-88. [PMID: 11181155 DOI: 10.1086/318817] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2000] [Revised: 10/19/2000] [Indexed: 11/03/2022] Open
Abstract
Pleural tuberculosis (TB) was employed as a model to study T cell apoptosis at sites of active Mycobacterium tuberculosis (MTB) infection in human immunodeficiency virus (HIV)-coinfected (HIV/TB) patients and patients infected with TB alone. Apoptosis in blood and in pleural fluid mononuclear cells and cytokine immunoreactivities in plasma and in pleural fluid were evaluated. T cells were expanded at the site of MTB infection, irrespective of HIV status. Apoptosis of CD4 and non-CD4 T cells in the pleural space occurred in both HIV/TB and TB. Interferon (IFN)-gamma levels were increased in pleural fluid, compared with plasma. Spontaneous apoptosis correlated with specific loss of MTB-reactive, IFN-gamma-producing pleural T cells. Immunoreactivities of molecules potentially involved in apoptosis, such as tumor necrosis factor-alpha, Fas-ligand, and Fas, were increased in pleural fluid, compared with plasma. These data suggest that continued exposure of immunoreactive cells to MTB at sites of infection may initiate a vicious cycle in which immune activation and loss of antigen-responsive T cells occur concomitantly, thus favoring persistence of MTB infection.
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Affiliation(s)
- C S Hirsch
- Case Western Reserve University, University Hospitals of Cleveland, Dept. of Medicine, Division of Infectious Diseases, Cleveland, OH 44106-4984, USA.
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