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Sinha P, Ezhumalai K, Du X, Ponnuraja C, Dauphinais MR, Gupte N, Sarkar S, Gupta A, Gaikwad S, Thangakunam B, Paradkar M, Christopher DJ, Mave V, Viswanathan V, Ellner JJ, Kornfeld H, Horsburgh CR, Padmapriyadarsini C, Gupte A. Undernourished Household Contacts Are at Increased Risk of Tuberculosis (TB) Disease, but not TB Infection- a Multicenter Prospective Cohort Analysis. Clin Infect Dis 2024:ciae149. [PMID: 38652286 DOI: 10.1093/cid/ciae149] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Indexed: 04/25/2024] Open
Abstract
Undernutrition is the leading risk factor for tuberculosis (TB) globally and in India. This multicenter prospective cohort analysis from India suggests that undernutrition is associated with increased risk of TB disease but not TB infection among household contacts of persons with TB.
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Affiliation(s)
- Pranay Sinha
- Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Komala Ezhumalai
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Xinyi Du
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Chinnaiyan Ponnuraja
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Madolyn Rose Dauphinais
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Center for Infectious Diseases in India, Johns Hopkins India, Pune, Maharashtra, India
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Amita Gupta
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Sanjay Gaikwad
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, BJMC Clinical Research Site, Pune, Maharashtra, India
| | | | - Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Center for Infectious Diseases in India, Johns Hopkins India, Pune, Maharashtra, India
| | | | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Center for Infectious Diseases in India, Johns Hopkins India, Pune, Maharashtra, India
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Vijay Viswanathan
- Prof. M. Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu, India
| | - Jerrold J Ellner
- Center for Emerging Pathogens, Department of Medicine, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Hardy Kornfeld
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - C R Horsburgh
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Akshay Gupte
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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Cox SR, Kadam A, Atre S, Gupte AN, Sohn H, Gupte N, Sawant T, Mhadeshwar V, Thompson R, Kendall E, Hofmann C, Suryavanshi N, Kerrigan D, Tripathy S, Kakrani A, Barthwal MS, Mave V, Golub JE. Correction: Tuberculosis (TB) Aftermath: study protocol for a hybrid type I effectiveness-implementation non-inferiority randomized trial in India comparing two active case finding (ACF) strategies among individuals treated for TB and their household contacts. Trials 2024; 25:178. [PMID: 38468342 DOI: 10.1186/s13063-024-07984-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Affiliation(s)
- Samyra R Cox
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA.
| | - Abhay Kadam
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Sachin Atre
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Akshay N Gupte
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Hojoon Sohn
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Nikhil Gupte
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Trupti Sawant
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Vishal Mhadeshwar
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Ryan Thompson
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Emily Kendall
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Christopher Hofmann
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Nishi Suryavanshi
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Deanna Kerrigan
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- George Washington University, 2121 I St NW, Washington, D.C, 20052, USA
| | - Srikanth Tripathy
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Arjunlal Kakrani
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Madhusudan S Barthwal
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Vidya Mave
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Jonathan E Golub
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
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Pardeshi G, Mave V, Gaikwad S, Kadam D, Barthwal M, Gupte N, Atre S, Deshmukh S, Golub JE, Gupte A. Glycated Hemoglobin Trajectories and Their Association With Treatment Outcomes Among Patients With Pulmonary TB in India: A Prospective Cohort Study. Chest 2024; 165:278-287. [PMID: 37673207 PMCID: PMC10851276 DOI: 10.1016/j.chest.2023.08.026] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/30/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Transient hyperglycemia is seen commonly during TB treatment, yet its association with unfavorable treatment outcomes is unclear. RESEARCH QUESTION Does an association exist between glycated hemoglobin (HbA1c) trajectories and TB treatment outcomes? STUDY DESIGN AND METHODS Adults with pulmonary TB were evaluated prospectively for 18 months after the second HbA1c measurement. HbA1c trajectories during the initial 3 months of treatment were defined as follows: persistent euglycemia, HbA1c < 6.5% at baseline and 3-month follow-up; persistent hyperglycemia, HbA1c ≥ 6.5% at baseline and 3-month follow-up; transient hyperglycemia, HbA1c ≥ 6.5% at baseline and < 6.5% at 3-month follow-up; incident hyperglycemia, HbA1c < 6.5% at baseline and ≥ 6.5% at 3-month follow-up. Multivariable Poisson regression was used to measure the association between HbA1c trajectories and unfavorable treatment outcomes of failure, recurrence, and all-cause mortality. RESULTS Of the 587 participants, 443 participants (76%) had persistent euglycemia, 118 participants (20%) had persistent hyperglycemia, and 26 participants (4%) had transient hyperglycemia. One participant had incident hyperglycemia and was excluded. Compared with participants with persistent euglycemia, those with transient hyperglycemia showed a twofold higher risk of experiencing an unfavorable treatment outcome (adjusted incidence rate ratio [aIRR], 2.07; 95% CI, 1.04-4.15) after adjusting for confounders including diabetes treatment, and BMI; we did not find a significant association with persistent hyperglycemia (aIRR, 1.64; 95% CI, 0.71-3.79). Diabetes treatment was associated with a significantly lower risk of unfavorable treatment outcomes (aIRR, 0.38; 95% CI, 0.15-0.95). INTERPRETATION Transient hyperglycemia and lack of diabetes treatment was associated with a higher risk of unfavorable treatment outcomes in adults with pulmonary TB.
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Affiliation(s)
- Geeta Pardeshi
- Department of Community Medicine, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai, India
| | - Vidya Mave
- Byramjee Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sanjay Gaikwad
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Dileep Kadam
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Madhusudan Barthwal
- Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sachin Atre
- Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Sona Deshmukh
- Byramjee Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Jonathan E Golub
- Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Akshay Gupte
- Department of Global Health, Boston University School of Public Health, Boston, MA.
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Jalbert E, Liu C, Mave V, Lang N, Kagal A, Valvi C, Paradkar M, Gupte N, Lokhande R, Bharadwaj R, Kulkarni V, Gupta A, Weinberg A. Comparative immune responses to Mycobacterium tuberculosis in people with latent infection or sterilizing protection. iScience 2023; 26:107425. [PMID: 37564701 PMCID: PMC10410524 DOI: 10.1016/j.isci.2023.107425] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 03/22/2023] [Accepted: 07/17/2023] [Indexed: 08/12/2023] Open
Abstract
There is great need for vaccines against tuberculosis (TB) more efficacious than the licensed BCG. Our goal was to identify new vaccine benchmarks by identifying immune responses that distinguish individuals able to eradicate the infection (TB-resisters) from individuals with latent infection (LTBI-participants). TB-resisters had higher frequencies of circulating CD8+ glucose monomycolate (GMM)+ Granzyme-B+ T cells than LTBI-participants and higher proportions of polyfunctional conventional and nonconventional T cells expressing Granzyme-B and/or PD-1 after ex vivo M. tuberculosis stimulation of blood mononuclear cells. LTBI-participants had higher expression of activation markers and cytokines, including IL10, and IFNγ. An exploratory analysis of BCG-recipients with minimal exposure to TB showed absence of CD8+GMM+Granzyme-B+ T cells, lower or equal proportions of Granzyme-B+PD-1+ polyfunctional T cells than TB-resisters and higher or equal than LTBI-participants. In conclusion, high Granzyme-B+PD-1+ T cell responses to M. tuberculosis and, possibly, of CD8+GMM+Granzyme-B+ T cells may be desirable for new TB vaccines.
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Affiliation(s)
- Emilie Jalbert
- Department of Pediatrics, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Cuining Liu
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, Maharashtra, India
- Johns Hopkins Center for Infectious Diseases in India, Pune, Maharashtra, India
- School of Medicine, Center for Clinical Global Health Education (CCGHE), Johns Hopkins University, Baltimore, MD, USA
| | - Nancy Lang
- Department of Pediatrics, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Anju Kagal
- Department of Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Chhaya Valvi
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, Maharashtra, India
- Johns Hopkins Center for Infectious Diseases in India, Pune, Maharashtra, India
- School of Medicine, Center for Clinical Global Health Education (CCGHE), Johns Hopkins University, Baltimore, MD, USA
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, Maharashtra, India
- Johns Hopkins Center for Infectious Diseases in India, Pune, Maharashtra, India
- School of Medicine, Center for Clinical Global Health Education (CCGHE), Johns Hopkins University, Baltimore, MD, USA
| | - Rahul Lokhande
- Department of Pulmonary Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Renu Bharadwaj
- Department of Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, Maharashtra, India
- Johns Hopkins Center for Infectious Diseases in India, Pune, Maharashtra, India
- School of Medicine, Center for Clinical Global Health Education (CCGHE), Johns Hopkins University, Baltimore, MD, USA
| | - Amita Gupta
- Johns Hopkins Center for Infectious Diseases in India, Pune, Maharashtra, India
- School of Medicine, Center for Clinical Global Health Education (CCGHE), Johns Hopkins University, Baltimore, MD, USA
| | - Adriana Weinberg
- Departments of Pediatrics, Medicine and Pathology, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA
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Sinha P, Ponnuraja C, Gupte N, Prakash Babu S, Cox SR, Sarkar S, Mave V, Paradkar M, Cintron C, Govindarajan S, Kinikar A, Priya N, Gaikwad S, Thangakunam B, Devarajan A, Dhanasekaran M, Tornheim JA, Gupta A, Salgame P, Christopher DJ, Kornfeld H, Viswanathan V, Ellner JJ, Horsburgh CR, Gupte AN, Padmapriyadarsini C, Hochberg NS. Impact of Undernutrition on Tuberculosis Treatment Outcomes in India: A Multicenter, Prospective, Cohort Analysis. Clin Infect Dis 2023; 76:1483-1491. [PMID: 36424864 PMCID: PMC10319769 DOI: 10.1093/cid/ciac915] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/10/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Undernutrition is the leading risk factor for tuberculosis (TB) globally. Its impact on treatment outcomes is poorly defined. METHODS We conducted a prospective cohort analysis of adults with drug-sensitive pulmonary TB at 5 sites from 2015-2019. Using multivariable Poisson regression, we assessed associations between unfavorable outcomes and nutritional status based on body mass index (BMI) nutritional status at treatment initiation, BMI prior to TB disease, stunting, and stagnant or declining BMI after 2 months of TB treatment. Unfavorable outcome was defined as a composite of treatment failure, death, or relapse within 6 months of treatment completion. RESULTS Severe undernutrition (BMI <16 kg/m2) at treatment initiation and severe undernutrition before the onset of TB disease were both associated with unfavorable outcomes (adjusted incidence rate ratio [aIRR], 2.05; 95% confidence interval [CI], 1.42-2.91 and aIRR, 2.20; 95% CI, 1.16-3.94, respectively). Additionally, lack of BMI increase after treatment initiation was associated with increased unfavorable outcomes (aIRR, 1.81; 95% CI, 1.27-2.61). Severe stunting (height-for-age z score <-3) was associated with unfavorable outcomes (aIRR, 1.52; 95% CI, 1.00-2.24). Severe undernutrition at treatment initiation and lack of BMI increase during treatment were associated with a 4- and 5-fold higher rate of death, respectively. CONCLUSIONS Premorbid undernutrition, undernutrition at treatment initiation, lack of BMI increase after intensive therapy, and severe stunting are associated with unfavorable TB treatment outcomes. These data highlight the need to address this widely prevalent TB comorbidity. Nutritional assessment should be integrated into standard TB care.
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Affiliation(s)
- Pranay Sinha
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Chinnaiyan Ponnuraja
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospitals–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Center for Infectious Diseases in India, Johns Hopkins India, Pune, Maharashtra, India
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | | | - Samyra R Cox
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Sonali Sarkar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospitals–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Center for Infectious Diseases in India, Johns Hopkins India, Pune, Maharashtra, India
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospitals–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Center for Infectious Diseases in India, Johns Hopkins India, Pune, Maharashtra, India
| | - Chelsie Cintron
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - S Govindarajan
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
- National Tuberculosis Elimination Program, Puducherry, India
| | - Aarti Kinikar
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Nadesan Priya
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Sanjay Gaikwad
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | | | | | | | - Jeffrey A Tornheim
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Amita Gupta
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Padmini Salgame
- Center for Emerging Pathogens, Department of Medicine, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | | | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Vijay Viswanathan
- Prof. M. Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu, India
| | - Jerrold J Ellner
- Center for Emerging Pathogens, Department of Medicine, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - C Robert Horsburgh
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Akshay N Gupte
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | | | - Natasha S Hochberg
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Deshmukh S, Sane M, Gaikwad S, Sahasrabudhe T, Barthwal M, Lokhande R, Raskar S, Kagal A, Dharmshale S, Pradhan N, Gupte A, Alfarisi O, Gupta A, Dooley KE, Gupte N, Golub JE, Mave V. Sex Differences in TB Clinical Presentation, Drug Exposure, and Treatment Outcomes in India. Chest 2023; 163:778-789. [PMID: 36174745 PMCID: PMC10258435 DOI: 10.1016/j.chest.2022.09.024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 08/25/2022] [Accepted: 09/09/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The role of sex differences in clinical presentation, TB drug pharmacokinetic variables, and treatment outcomes is unclear. RESEARCH QUESTION What is the effect of sex on TB disease severity, drug exposure, and treatment outcome? STUDY DESIGN AND METHODS This study was a prospective cohort study conducted in India. It assessed TB disease severity; risk of unfavorable treatment outcomes (failure, recurrence, and death) according to sex; and risk factors for unfavorable outcomes stratified according to sex. Effects of sex on the pharmacokinetic variables (maximum concentration and area under the curve) of rifampicin, isoniazid, and pyrazinamide were estimated by using noncompartmental analyses. RESULTS Of 1,541 people with microbiologically confirmed TB, 567 (37%) were women. Women had a lower risk of high mycobacterial burden (smear grade ≥ 2 and/or time to detection < 7 days) with an adjusted OR of 0.70 (95% CI, 0.56-0.87). Among the 744 participants who were followed up prospectively, 261 (35%) were women. Women had a lower risk of unfavorable treatment outcomes (adjusted incidence risk ratio, 0.60; 95% CI, 0.43-0.85), mostly because recurrence was lower (adjusted incidence risk ratio, 0.45; 95% CI, 0.23-0.86). Isoniazid (but not rifampicin and pyrazinamide) maximum concentration and area under the curve were significantly higher among women (P < .01) than men. Among women, unfavorable outcomes were more likely among those with cavitary disease, but among men, increased risk of unfavorable outcomes was associated with alcohol use, higher BMI, and lower glycated hemoglobin level. INTERPRETATION Women present with lower mycobacterial burden, achieve higher TB drug exposure, and are less likely to have unfavorable treatment outcomes than men. Strategies to improve TB treatment success should take into account sex differences in risk factors for unfavorable outcomes.
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Affiliation(s)
- Sona Deshmukh
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins India, Pune, India
| | - Manasi Sane
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins India, Pune, India
| | - Sanjay Gaikwad
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Tushar Sahasrabudhe
- Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Madhusudan Barthwal
- Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Rahul Lokhande
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Swapnil Raskar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins India, Pune, India
| | - Anju Kagal
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | - Neeta Pradhan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins India, Pune, India
| | - Akshay Gupte
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kelly E Dooley
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins India, Pune, India; Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan E Golub
- Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins India, Pune, India; Johns Hopkins University School of Medicine, Baltimore, MD.
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Dooley KE, Hendricks B, Gupte N, Barnes G, Narunsky K, Whitelaw C, Smit T, Ignatius EH, Friedman A, Dorman SE, Dawson R. Assessing Pretomanid for Tuberculosis (APT), a Randomized Phase 2 Trial of Pretomanid-Containing Regimens for Drug-Sensitive Tuberculosis: 12-Week Results. Am J Respir Crit Care Med 2023; 207:929-935. [PMID: 36455068 DOI: 10.1164/rccm.202208-1475oc] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
Rationale: Pretomanid is a new nitroimidazole with proven treatment-shortening efficacy in drug-resistant tuberculosis. Pretomanid-rifamycin-pyrazinamide combinations are potent in mice but have not been tested clinically. Rifampicin, but not rifabutin, reduces pretomanid exposures. Objectives: To evaluate the safety and efficacy of regimens containing pretomanid-rifamycin-pyrazinamide among participants with drug-sensitive pulmonary tuberculosis. Methods: A phase 2, 12-week, open-label randomized trial was conducted of isoniazid and pyrazinamide plus 1) pretomanid and rifampicin (arm 1), 2) pretomanid and rifabutin (arm 2), or 3) rifampicin and ethambutol (standard of care; arm 3). Laboratory values of safety and sputum cultures were collected at Weeks 1, 2, 3, 4, 6, 8, 10, and 12. Time to culture conversion on liquid medium was the primary outcome. Measurements and Main Results: Among 157 participants, 125 (80%) had cavitary disease. Median time to liquid culture negativity in the modified intention-to-treat population (n = 150) was 42 (arm 1), 28 (arm 2), and 56 (arm 3) days (P = 0.01) (adjusted hazard ratio for arm 1 vs. arm 3, 1.41 [95% confidence interval (CI), 0.93-2.12; P = 0.10]; adjusted hazard ratio for arm 2 vs. arm 3, 1.89 [95% CI, 1.24-2.87; P = 0.003]). Eight-week liquid culture conversion was 79%, 89%, and 69%, respectively. Grade ≥3 adverse events occurred in 3 of 56 (5%), 5 of 53 (9%), and 2 of 56 (4%) participants. Six participants were withdrawn because of elevated transaminase concentrations (five in arm 2, one in arm 1). There were three serious adverse events (arm 2) and no deaths. Conclusions: Pretomanid enhanced the microbiologic activity of regimens containing a rifamycin and pyrazinamide. Efficacy and hepatic adverse events appeared highest with the pretomanid and rifabutin-containing regimen. Whether this is due to higher pretomanid concentrations merits exploration. Clinical trial registered with www.clinicaltrials.gov (NCT02256696).
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Affiliation(s)
- Kelly E Dooley
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bronwyn Hendricks
- Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Nikhil Gupte
- Johns Hopkins India Private Limited, Pune, India
| | - Grace Barnes
- School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Kim Narunsky
- Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Colleen Whitelaw
- Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Tanya Smit
- Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Elisa H Ignatius
- School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Adine Friedman
- Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Susan E Dorman
- Medical University of South Carolina, Charleston, South Carolina
| | - Rodney Dawson
- Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa
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Keke C, Wilson Z, Lebina L, Motlhaoleng K, Abrams D, Variava E, Gupte N, Niaura R, Martinson N, Golub JE, Elf JL. A Cross-Sectional Analysis of the Nicotine Metabolite Ratio and Its Association with Sociodemographic and Smoking Characteristics among People with HIV Who Smoke in South Africa. Int J Environ Res Public Health 2023; 20:5090. [PMID: 36982002 PMCID: PMC10049339 DOI: 10.3390/ijerph20065090] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
The nicotine metabolite ratio (NMR) is associated with race/ethnicity but has not been evaluated among smokers in the African region. We conducted a cross-sectional analysis of baseline data from a large randomized, controlled trial for smoking cessation among people with HIV (PWH) in South Africa. Urine samples were analyzed for the NMR and evaluated as a binary variable using a cutoff value of the fourth quartile to determine the fastest metabolizers. The median NMR was 0.31 (IQR: 0.31, 0.32; range: 0.29, 0.57); the cut-point for fast metabolizers was ≥0.3174 ng/mL. A high NMR was not associated with the number of cigarettes per day (OR = 1.10, 95% CI: 0.71, 1.70, p = 0.66) but was associated with 40% lower odds of a quit attempt in the past year (OR = 0.69; 95% CI: 0.44, 1.07, p = 0.09) and alcohol use (OR = 0.59, 95% CI: 0.32, 1.06, p = 0.07). No association was seen with marijuana or HIV clinical characteristics. As we found only minimal variability in the NMR and minimal associations with intensity of smoking, NMR may be of limited clinical value in this population, although it may inform which individuals are less likely to make a quit attempt.
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Affiliation(s)
- Chukwudi Keke
- Department of Environmental and Radiological Health Science, Colorado State University, Fort Collins, CO 80523, USA
| | - Zane Wilson
- Department of Environmental and Radiological Health Science, Colorado State University, Fort Collins, CO 80523, USA
| | - Limakatso Lebina
- Africa Health Research Institute, Somkhele, Myeki 3935, South Africa
| | | | - David Abrams
- School of Global Public Health, New York University, New York, NY 10003, USA
| | - Ebrahim Variava
- Klerksdorp Tshepong Hospital Complex, Matlosana 2574, South Africa
| | - Nikhil Gupte
- Department of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Raymond Niaura
- School of Global Public Health, New York University, New York, NY 10003, USA
| | | | - Jonathan E. Golub
- Department of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Jessica L. Elf
- Department of Environmental and Radiological Health Science, Colorado State University, Fort Collins, CO 80523, USA
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9
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Priddy LB, Krishnan L, Hettiaratchi MH, Karthikeyakannan S, Gupte N, Guldberg RE. Amniotic membrane attenuates heterotopic ossification following high-dose bone morphogenetic protein-2 treatment of segmental bone defects. J Orthop Res 2023; 41:130-140. [PMID: 35340049 PMCID: PMC9512937 DOI: 10.1002/jor.25324] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/31/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023]
Abstract
Treatment of large bone defects with supraphysiological doses of bone morphogenetic protein-2 (BMP-2) has been associated with complications including heterotopic ossification (HO), inflammation, and pain, presumably due to poor spatiotemporal control of BMP-2. We have previously recapitulated extensive HO in our rat femoral segmental defect model by treatment with high-dose BMP-2 (30 μg). Using this model and BMP-2 dose, our objective was to evaluate the utility of a clinically available human amniotic membrane (AM) around the defect space for guided bone regeneration and reduction of HO. We hypothesized that AM surrounding collagen sponge would attenuate heterotopic ossification compared with collagen sponge alone. In vitro, AM retained more BMP-2 than a synthetic poly(ε-caprolactone) membrane through 21 days. In vivo, as hypothesized, the collagen + AM resulted in significantly less heterotopic ossification and correspondingly, lower total bone volume (BV), compared with collagen sponge alone. Although bone formation within the defect was delayed with AM around the defect, by 12 weeks, defect BVs were equivalent. Torsional stiffness was significantly reduced with AM but was equivalent to that of intact bone. Collagen + AM resulted in the formation of dense fibrous tissue and mineralized tissue, while the collagen group contained primarily mineralized tissue surrounded by marrow-like structures. Especially in conjunction with high doses of growth factor delivered via collagen sponge, these findings suggest AM may be effective as an overlay adjacent to bone healing sites to spatially direct bone regeneration and minimize heterotopic ossification.
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Affiliation(s)
- Lauren B. Priddy
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, 315 Ferst Drive NW, Atlanta, GA 30332, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive NW, Atlanta, GA 30332, USA
- Current affiliation: Department of Agricultural and Biological Engineering, Mississippi State University, 130 Creelman Street, Mississippi State, MS 39762, USA
| | - Laxminarayanan Krishnan
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, 315 Ferst Drive NW, Atlanta, GA 30332, USA
| | - Marian H. Hettiaratchi
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, 315 Ferst Drive NW, Atlanta, GA 30332, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive NW, Atlanta, GA 30332, USA
- Current affiliation: Phil and Penny Knight Campus for Accelerating Scientific Impact, University of Oregon, 6231 University of Oregon, Eugene, OR 97403, USA
| | - Sukhita Karthikeyakannan
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, 315 Ferst Drive NW, Atlanta, GA 30332, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive NW, Atlanta, GA 30332, USA
| | - Nikhil Gupte
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, 315 Ferst Drive NW, Atlanta, GA 30332, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive NW, Atlanta, GA 30332, USA
| | - Robert E. Guldberg
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, 315 Ferst Drive NW, Atlanta, GA 30332, USA
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, 801 Ferst Drive NW, Atlanta, GA 30332, USA
- Current affiliation: Phil and Penny Knight Campus for Accelerating Scientific Impact, University of Oregon, 6231 University of Oregon, Eugene, OR 97403, USA
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10
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Salvi S, Raichur P, Kadam D, Sangle S, Gupte N, Nevrekar N, Patil S, Chavan A, Nimkar S, Marbaniang I, Mave V. Virological failure among people living with HIV receiving second-line antiretroviral therapy in Pune, India. BMC Infect Dis 2022; 22:951. [PMID: 36528762 PMCID: PMC9758821 DOI: 10.1186/s12879-022-07894-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The number of people receiving second-line antiretroviral therapy (ART) has increased as global access to ART has expanded. Data on the burden and factors associated with second-line ART virologic failure (VF) from India remain limited. METHODS We conducted cross-sectional viral load (VL) testing among adults (≥ 18 years) who were registered at a publicly funded ART center in western India between 2014 and 2015 and had received second-line ART for at least 6 months. Sociodemographic and clinical characteristics were abstracted from routinely collected programmatic data. Logistic regression evaluated factors associated with VF (defined as VL > 1000 copies/mL). RESULTS Among 400 participants, median age was 40 years (IQR 34-44), 71% (285/400) were male, and 15% (59/400) had VF. Relative to participants without VF, those with VF had lower median CD4 counts (230 vs 406 cells/mm3, p < 0.0001), lower weight at first-line failure (49 vs 52 kg, p = 0.003), were more likely to have an opportunistic infection (17% vs 3%, p < 0.0001) and less likely to have optimal ART adherence (71% vs 87%, p = 0.005). In multivariable analysis, VF was associated with opportunistic infection (aOR, 4.84; 95% CI, 1.77-13.24), lower CD4 count (aOR 4.15; 95% CI, 1.98-8.71) and lower weight at first-line failure (aOR, 2.67; 95% CI, 1.33-5.34). CONCLUSIONS We found second-line VF in about a sixth of participants in our setting, which was associated with nearly fivefold increased odds in the context of opportunistic infection. Weight could be a useful clinical indicator for second-line VF.
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Affiliation(s)
- Sonali Salvi
- grid.452248.d0000 0004 1766 9915Department of Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jai Prakash Narayan Road, Pune, India
| | - Priyanka Raichur
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Dileep Kadam
- grid.452248.d0000 0004 1766 9915Department of Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jai Prakash Narayan Road, Pune, India
| | - Shashikala Sangle
- grid.452248.d0000 0004 1766 9915Department of Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jai Prakash Narayan Road, Pune, India
| | - Nikhil Gupte
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India ,grid.21107.350000 0001 2171 9311Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Neetal Nevrekar
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Sandesh Patil
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Amol Chavan
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Smita Nimkar
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Ivan Marbaniang
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India ,grid.14709.3b0000 0004 1936 8649Department of Epidemiology, McGill University, Montreal, QC Canada
| | - Vidya Mave
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India ,grid.21107.350000 0001 2171 9311Johns Hopkins University School of Medicine, Baltimore, MD USA
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11
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Cox SR, Kadam A, Atre S, Gupte AN, Sohn H, Gupte N, Sawant T, Mhadeshwar V, Thompson R, Kendall E, Hoffmann C, Suryavanshi N, Kerrigan D, Tripathy S, Kakrani A, Barthwal MS, Mave V, Golub JE. Tuberculosis (TB) Aftermath: study protocol for a hybrid type I effectiveness-implementation non-inferiority randomized trial in India comparing two active case finding (ACF) strategies among individuals treated for TB and their household contacts. Trials 2022; 23:635. [PMID: 35932062 PMCID: PMC9354295 DOI: 10.1186/s13063-022-06503-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/01/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Approximately 7% of all reported tuberculosis (TB) cases each year are recurrent, occurring among people who have had TB in the recent or distant past. TB recurrence is particularly common in India, which has the largest TB burden worldwide. Although patients recently treated for TB are at high risk of developing TB again, evidence around effective active case finding (ACF) strategies in this population is scarce. We will conduct a hybrid type I effectiveness-implementation non-inferiority randomized trial to compare the effectiveness, cost-effectiveness, and feasibility of two ACF strategies among individuals who have completed TB treatment and their household contacts (HHCs). METHODS We will enroll 1076 adults (≥ 18 years) who have completed TB treatment at a public TB unit (TU) in Pune, India, along with their HHCs (averaging two per patient, n = 2152). Participants will undergo symptom-based ACF by existing healthcare workers (HCWs) at 6-month intervals and will be randomized to either home-based ACF (HACF) or telephonic ACF (TACF). Symptomatic participants will undergo microbiologic testing through the program. Asymptomatic HHCs will be referred for TB preventive treatment (TPT) per national guidelines. The primary outcome is rate per 100 person-years of people diagnosed with new or recurrent TB by study arm, within 12 months following treatment completion. The secondary outcome is proportion of HHCs < 6 years, by study arm, initiated on TPT after ruling out TB disease. Study staff will collect socio-demographic and clinical data to identify risk factors for TB recurrence and will measure post-TB lung impairment. In both arms, an 18-month "mop-up" visit will be conducted to ascertain outcomes. We will use the RE-AIM framework to characterize implementation processes and explore acceptability through in-depth interviews with index patients, HHCs and HCWs (n = 100). Cost-effectiveness will be assessed by calculating the incremental cost per TB case detected within 12 months and projected for disability-adjusted life years averted based on modeled estimates of morbidity, mortality, and time with infectious TB. DISCUSSION This novel trial will guide India's scale-up of post-treatment ACF and provide an evidence base for designing strategies to detect recurrent and new TB in other high burden settings. TRIAL REGISTRATION NCT04333485 , registered April 3, 2020. CTRI/2020/05/025059 [Clinical Trials Registry of India], registered May 6 2020.
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Affiliation(s)
- Samyra R Cox
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA.
| | - Abhay Kadam
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Sachin Atre
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Akshay N Gupte
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Hojoon Sohn
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Nikhil Gupte
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Trupti Sawant
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Vishal Mhadeshwar
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Ryan Thompson
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Emily Kendall
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Christopher Hoffmann
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Nishi Suryavanshi
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Deanna Kerrigan
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- George Washington University, 2121 I St NW, Washington, D.C., 20052, USA
| | - Srikanth Tripathy
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Arjunlal Kakrani
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Madhusudan S Barthwal
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Vidya Mave
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Jonathan E Golub
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
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12
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Atre S, Barthwal M, Gaikwad S, Sawant T, Sahasrabudhe T, Kakrani A, Lokhande R, Deshmukh S, Raskar S, Hodgar B, Jadhav V, Gupte N, Gupta A, Golub J, Mave V. Cascade of care for people with TB and diabetes in India. Int J Tuberc Lung Dis 2022; 26:787-788. [PMID: 35898132 DOI: 10.5588/ijtld.22.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- S Atre
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - M Barthwal
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - S Gaikwad
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - T Sawant
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - T Sahasrabudhe
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - A Kakrani
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - R Lokhande
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - S Deshmukh
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - S Raskar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | | | | | - N Gupte
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - A Gupta
- Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J Golub
- Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - V Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, Johns Hopkins School of Medicine, Baltimore, MD, USA
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13
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Chebrolu P, Alexander M, Bhosale R, Naik S, Gupte N, Lee MH, Kumar P, Babu S, Fitzgerald DW, Gupta A, Mathad JS. The Association of Gestational Diabetes with HIV Infection and Tuberculosis in Indian Women. Am J Trop Med Hyg 2022; 107:tpmd211106. [PMID: 35914684 PMCID: PMC9490672 DOI: 10.4269/ajtmh.21-1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/10/2022] [Indexed: 11/07/2022] Open
Abstract
Infection of HIV is associated with an increased diabetes risk, which also increases tuberculosis risk. It is unknown if similar associations exist with gestational diabetes (GDM). We screened pregnant women living with and without HIV for GDM using oral glucose tolerance testing. In a subgroup of women with latent tuberculosis (positive interferon-gamma [IFN-γ] release assay), we used supernatants from tuberculosis antigen tubes to compare cytokine levels from women with and without GDM, matched by age and HIV status. Of 234 women, 21 (9%) had GDM, 13.9% living with HIV, and 6.5% without HIV (P = 0.06). Compared with women without GDM, women with GDM had lower median IFN-γ (19.1 versus 141.9 pg/mL, P = 0.03) and interleukin-2 (18.7 versus 249 pg/mL, P < 0.01). Our study suggests that HIV infection is associated with an increased risk of GDM, which is associated with decreased Mycobacterium tuberculosis immune responses. Gestational diabetes screening should be prioritized in tuberculosis-endemic countries, especially in women living with HIV.
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Affiliation(s)
- Puja Chebrolu
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York
| | - Mallika Alexander
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Trial Unit, Pune, Maharashtra, India
| | - Ramesh Bhosale
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Trial Unit, Pune, Maharashtra, India
- Department of OB-GYN, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Shilpa Naik
- Department of OB-GYN, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Trial Unit, Pune, Maharashtra, India
- Division of Infectious Diseases, Departments of Medicine and International Health, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Myung Hee Lee
- Department of Biostatistics, Center for Global Health, Weill Cornell Medicine, New York, New York
| | - Pavan Kumar
- National Institute for Research in Tuberculosis, Chennai, India
| | - Subash Babu
- National Institute for Research in Tuberculosis, Chennai, India
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Daniel W. Fitzgerald
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York
| | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Trial Unit, Pune, Maharashtra, India
- Division of Infectious Diseases, Departments of Medicine and International Health, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jyoti S. Mathad
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York
- Department of OB-GYN, Weill Cornell Medicine, New York, New York
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14
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Teeraananchai S, Law M, Boettiger D, Mata NDL, Gupte N, Chan YTL, Pham TN, Chaiwarith R, Ly PS, Chan YJ, Kiertiburanakul S, Khusuwan S, Zhang F, Yunihastuti E, Kumarasamy N, Pujari S, Azwa I, Somia IKA, Tanuma J, Ditangco R, Choi JY, Ng OT, Do CD, Gani Y, Ross J, Jiamsakul A. Virological failure and treatment switch after ART initiation among people living with HIV with and without routine viral load monitoring in Asia. J Int AIDS Soc 2022; 25:e25989. [PMID: 36028921 PMCID: PMC9418417 DOI: 10.1002/jia2.25989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Viral load (VL) testing is still challenging to monitor treatment responses of antiretroviral therapy (ART) for HIV treatment programme in Asia. We assessed the association between routine VL testing and virological failure (VF) and determine factors associated with switching to second‐line regimen. Methods Among 21 sites from the TREAT Asia HIV Observational Database (TAHOD), people living with HIV (PLHIV) aged ≥18 years initiating ART from 2003 to 2021 were included. We calculated the average number of VL tests per patient per year between the date of ART initiation and the most recent visit. If the median average number of VL tests was ≥ 0.80 per patient per year, the site was classified as a routine VL site. A site with a median < 0.80 was classified into the non‐routine VL sites. VF was defined as VL ≥1000 copies/ml during first‐line therapy. Factors associated with VF were analysed using generalized estimating equations with Poisson distribution. Results Of 6277 PLHIV starting ART after 2003, 3030 (48%) were from 11 routine VL testing sites and 3247 (52%) were from 10 non‐routine VL testing sites. The median follow‐up was 9 years (IQR 5–13). The median age was 35 (30–42) years; 68% were male and 5729 (91%) started non‐nucleoside reverse‐transcriptase inhibitor‐based regimen. The median pre‐ART CD4 count in PLHIV from routine VL sites was lower compared to non‐routine VL sites (144 vs. 156 cells/mm3, p <0.001). Overall, 1021 subsequent VF at a rate of 2.15 (95% CI 2.02–2.29) per 100 person‐years (PY). VF was more frequent at non‐routine VL sites (adjusted incidence rate ratio 2.85 [95% CI 2.27–3.59]) compared to routine VL sites. Other factors associated with an increased rate of VF were age <50 years and CD4 count <350 cells/mm3. A total of 817 (13%) patients switched to second‐line regimen at a rate of 1.44 (95% CI 1.35–1.54) per 100 PY. PLHIV at routine VL monitoring sites were at higher risk of switching than those at non‐routine VL sites (adjusted sub‐hazard ratio 1.78 95% CI [1.17–2.71]). Conclusions PLHIV from non‐routine VL sites had a higher incidence of persistent VF and a low switching regimen rate, reflecting possible under‐utilized VL testing.
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Affiliation(s)
- Sirinya Teeraananchai
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand.,HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Matthew Law
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - David Boettiger
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Nicole De La Mata
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nikhil Gupte
- BJ Government Medical College and Sassoon General Hospital, Pune, India
| | | | | | - Romanee Chaiwarith
- Chiang Mai University - Research Institute for Health Sciences, Chiang Mai, Thailand.,Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Penh Sun Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - Yu-Jiun Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Evy Yunihastuti
- Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | | | - Iskandar Azwa
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - I Ketut Agus Somia
- Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia
| | - Junko Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Rossana Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | - Yasmin Gani
- Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | | | -
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
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15
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Marbaniang I, Joshi S, Sangle S, Khaire S, Thakur R, Chavan A, Gupte N, Kulkarni V, Deshpande P, Nimkar S, Mave V. Smokeless tobacco use and oral potentially malignant disorders among people living with HIV (PLHIV) in Pune, India: Implications for oral cancer screening in PLHIV. PLoS One 2022; 17:e0270876. [PMID: 35788753 PMCID: PMC9255739 DOI: 10.1371/journal.pone.0270876] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 06/17/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION In India, smokeless tobacco (SLT) is a predominant form of tobacco used among people living with HIV (PLHIV). Despite SLT being a risk factor for oral potentially malignant disorders (OPMDs), no prior studies have quantified the association of OPMDs with SLT use among PLHIV. This limits the planning of preventive and control strategies for oral cancer among PLHIV, who are at higher risk for the disease. METHODS We enrolled 601 PLHIV and 633 HIV-uninfected individuals in an oral cancer screening study at BJ Government Medical College, Pune, India. Oral cavity images were collected using an m-Health application and reviewed by three clinicians. Participants with two clinician positive diagnoses were deemed to have suspected OPMDs. Prevalence ratios (PRs) were used to quantify the association between suspected OPMDs and SLT use among PLHIV. PRs for current SLT users, across HIV status and use duration were also estimated. Corrected PRs were obtained by modifying the maximum likelihood estimation. Models were adjusted for age, smoking, alcohol use and CD4 counts. RESULTS Of those enrolled, 61% were men, median age was 36 years (IQR: 28-44), and 33% currently use SLT. Proportion of current SLT users was similar across PLHIV and HIV-uninfected groups but use duration for current SLT use was higher among PLHIV(p<0.05). Among PLHIV, current SLT users had a 5-times (95% CI:3.1-7.0) higher prevalence of suspected OPMDs, compared to non-users. Relative to HIV uninfected individuals with the same SLT use duration, significant associations with suspected OPMDs were seen for PLHIV with<10 use years (PR: 3.5, 95% CI: 1.5-8.1) but not for PLHIV with≥10 use years (PR: 1.3, 95% CI: 0.9-1.8). CONCLUSION PLHIV that are current SLT users are at high risk of OPMDs and potentially oral cancer. The development of strategies for screening, early detection, and management of OPMDs must be considered for this group.
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Affiliation(s)
- Ivan Marbaniang
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
- Department of Epidemiology, McGill University, Montreal, Québec, Canada
- * E-mail:
| | - Samir Joshi
- Department of Otorhinolaryngology and Head & Neck Surgery, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Shashikala Sangle
- Department of Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Samir Khaire
- Department of Dentistry, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Rahul Thakur
- Department of Otorhinolaryngology and Head & Neck Surgery, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Amol Chavan
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
- Center for Clinical Global Health Education, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
| | - Prasad Deshpande
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
| | - Smita Nimkar
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
- Center for Clinical Global Health Education, Johns Hopkins University, Baltimore, Maryland, United States of America
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16
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De Jager V, Gupte N, Nunes S, Barnes GL, van Wijk RC, Mostert J, Dorman SE, Abulfathi AA, Upton CM, Faraj A, Nuermberger EL, Lamichhane G, Svensson EM, Simonsson USH, Diacon AH, Dooley KE. Early Bactericidal Activity of Meropenem plus Clavulanate (with or without Rifampin) for Tuberculosis: The COMRADE Randomized, Phase 2A Clinical Trial. Am J Respir Crit Care Med 2022; 205:1228-1235. [PMID: 35258443 PMCID: PMC9872811 DOI: 10.1164/rccm.202108-1976oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Rationale: Carbapenems are recommended for treatment of drug-resistant tuberculosis. Optimal dosing remains uncertain. Objectives: To evaluate the 14-day bactericidal activity of meropenem, at different doses, with or without rifampin. Methods: Individuals with drug-sensitive pulmonary tuberculosis were randomized to one of four intravenous meropenem-based arms: 2 g every 8 hours (TID) (arm C), 2 g TID plus rifampin at 20 mg/kg once daily (arm D), 1 g TID (arm E), or 3 g once daily (arm F). All participants received amoxicillin/clavulanate with each meropenem dose. Serial overnight sputum samples were collected from baseline and throughout treatment. Median daily fall in colony-forming unit (CFU) counts per milliliter of sputum (solid culture) (EBACFU0-14) and increase in time to positive culture (TTP) in liquid media were estimated with mixed-effects modeling. Serial blood samples were collected for pharmacokinetic analysis on Day 13. Measurements and Main Results: Sixty participants enrolled. Median EBACFU0-14 counts (2.5th-97.5th percentiles) were 0.22 (0.12-0.33), 0.12 (0.057-0.21), 0.059 (0.033-0.097), and 0.053 (0.035-0.081); TTP increased by 0.34 (0.21-0.75), 0.11 (0.052-0.37), 0.094 (0.034-0.23), and 0.12 (0.04-0.41) (log10 h), for arms C-F, respectively. Meropenem pharmacokinetics were not affected by rifampin coadministration. Twelve participants withdrew early, many of whom cited gastrointestinal adverse events. Conclusions: Bactericidal activity was greater with the World Health Organization-recommended total daily dose of 6 g daily than with a lower dose of 3 g daily. This difference was only detectable with solid culture. Tolerability of intravenous meropenem, with amoxicillin/clavulanate, though, was poor at all doses, calling into question the utility of this drug in second-line regimens. Clinical trial registered with www.clinicaltrials.gov (NCT03174184).
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Affiliation(s)
| | - Nikhil Gupte
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;,Johns Hopkins India, Pune, India
| | | | - Grace L. Barnes
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Susan E. Dorman
- Medical University of South Carolina, Charleston, South Carolina
| | - Ahmed A. Abulfathi
- Department of Medicine, Stellenbosch University, Cape Town, South Africa;,Department of Clinical Pharmacology and Therapeutics, University of Maiduguri, Maiduguri, Nigeria; and
| | | | - Alan Faraj
- Department of Pharmaceutical Biosciences and
| | - Eric L. Nuermberger
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gyanu Lamichhane
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elin M. Svensson
- Department of Pharmacy, Uppsala University, Uppsala, Sweden;,Department of Pharmacy, Radboud University, Njimegen, the Netherlands
| | | | | | - Kelly E. Dooley
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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17
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Shivakumar SVBY, Padmapriyadarsini C, Chavan A, Paradkar M, Shrinivasa BM, Gupte A, Dhanasekaran K, Thomas B, Suryavanshi N, Dolla CK, Selvaraju S, Kinikar A, Gaikwad S, Kohli R, Sivaramakrishnan GN, Pradhan N, Hanna LE, Kulkarni V, DeLuca A, Cox SR, Murali L, Thiruvengadam K, Raskar S, Ramachandran G, Golub JE, Gupte N, Mave V, Swaminathan S, Gupta A, Bollinger RC. Concomitant pulmonary disease is common among patients with extrapulmonary TB. Int J Tuberc Lung Dis 2022; 26:341-347. [PMID: 35351239 PMCID: PMC8982647 DOI: 10.5588/ijtld.21.0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND : Microbiologic screening of extrapulmonary TB (EPTB) patients could inform recommendations for aerosol precautions and close contact prophylaxis. However, this is currently not routinely recommended in India. Therefore, we estimated the proportion of Indian patients with EPTB with microbiologic evidence of pulmonary TB (PTB). METHODS : We characterized baseline clinical, radiological and sputum microbiologic data of 885 adult and pediatric TB patients in Chennai and Pune, India, between March 2014 and November 2018. RESULTS : Of 277 patients with EPTB, enhanced screening led to the identification of 124 (45%) with concomitant PTB, including 53 (19%) who reported a cough >2 weeks; 158 (63%) had an abnormal CXR and 51 (19%) had a positive sputum for TB. Of 70 participants with a normal CXR and without any cough, 14 (20%) had a positive sputum for TB. Overall, the incremental yield of enhanced screening of patients with EPTB to identify concomitant PTB disease was 14% (95% CI 12–16). CONCLUSIONS : A high proportion of patients classified as EPTB in India have concomitant PTB. Our results support the need for improved symptom and CXR screening, and recommends routine sputum TB microbiology screening of all Indian patients with EPTB.
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Affiliation(s)
| | - C Padmapriyadarsini
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - A Chavan
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - M Paradkar
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - B M Shrinivasa
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - A Gupte
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - K Dhanasekaran
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - B Thomas
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - N Suryavanshi
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - C K Dolla
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - S Selvaraju
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - A Kinikar
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - S Gaikwad
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - R Kohli
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - G N Sivaramakrishnan
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - N Pradhan
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - L E Hanna
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - V Kulkarni
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - A DeLuca
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - S R Cox
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - L Murali
- District Tuberculosis Office, Thiruvallur, India
| | - K Thiruvengadam
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - S Raskar
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - G Ramachandran
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - J E Golub
- Johns Hopkins School of Medicine, Baltimore, MD, USA, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - N Gupte
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - V Mave
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - A Gupta
- Johns Hopkins School of Medicine, Baltimore, MD, USA, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - R C Bollinger
- Johns Hopkins School of Medicine, Baltimore, MD, USA, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Pradhan NN, Paradkar MS, Kagal A, Valvi C, Kinikar A, Khwaja S, Dhage R, Chandane J, Ithape M, Bendre M, Madewar R, Nadgeri V, Nijampurkar A, Jain D, Gupte N, Gupta A, Mave V, Dooley KE, Thakur KT. Performance of Xpert ® MTB/RIF and Xpert ® Ultra for the diagnosis of tuberculous meningitis in children. Int J Tuberc Lung Dis 2022; 26:317-325. [PMID: 35351236 PMCID: PMC9592112 DOI: 10.5588/ijtld.21.0388] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE: To assess Xpert® MTB/RIF (Xpert) and Xpert® MTB/RIF Ultra (Ultra) performance in diagnosing pediatric tuberculous meningitis (TBM).METHODS: We conducted a study among children with suspected meningoencephalitis in Pune, India. Clinical, radiological, laboratory, and treatment data were analyzed to classify disease as definite, probable, possible or no TBM, using microbiologic or composite reference standards. We tested cerebrospinal fluid (CSF) either using Xpert or Ultra and estimated test performance characteristics.RESULTS: Of 341 participants, 149 (43.7%) were tested using Ultra and 192 (56.3%) with Xpert. Ultra had higher sensitivity (50% vs. 18%), lower specificity (91% vs. 99%), poor positive predictive value (PPV) (13% vs. 75%), and higher negative predictive value (NPV) (99% vs. 93%) than Xpert using the composite reference standard, with similar results by the microbiologic reference standard. Of 10 participants with trace positivity on Ultra, none met clinical TBM definitions.CONCLUSION: This is the first study to report on diagnostic performance of Ultra in pediatric TBM, which showed higher sensitivity and NPV than Xpert. For children presenting with nonspecific clinical features, Ultra is a promising diagnostic test. Further studies are required to define its optimal clinical use, including interpretation of trace positive results.
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Affiliation(s)
- N. N. Pradhan
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India;,Johns Hopkins India, Pune, India
| | - M. S. Paradkar
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India;,Johns Hopkins India, Pune, India
| | - A. Kagal
- BJ Government Medical College and Sassoon General Hospitals, Pune, India
| | - C. Valvi
- BJ Government Medical College and Sassoon General Hospitals, Pune, India
| | - A. Kinikar
- BJ Government Medical College and Sassoon General Hospitals, Pune, India
| | - S. Khwaja
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - R. Dhage
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - J. Chandane
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - M. Ithape
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - M. Bendre
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - R. Madewar
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - V. Nadgeri
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - A. Nijampurkar
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India;,Johns Hopkins India, Pune, India
| | - D. Jain
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - N. Gupte
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India;,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A. Gupta
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - V. Mave
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India;,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K. E. Dooley
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K. T. Thakur
- Department of Neurology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
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19
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Paradkar MS, Devaleenal D B, Mvalo T, Arenivas A, Thakur KT, Wolf L, Nimkar S, Inamdar S, Giridharan P, Selladurai E, Kinikar A, Valvi C, Khwaja S, Gadama D, Balaji S, Yadav Kattagoni K, Venkatesan M, Savic R, Swaminathan S, Gupta A, Gupte N, Mave V, Dooley KE. Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial. Clin Infect Dis 2022; 75:1594-1601. [PMID: 35291004 PMCID: PMC9617573 DOI: 10.1093/cid/ciac208] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Pediatric tuberculous meningitis (TBM) commonly causes death or disability. In adults, high-dose rifampicin may reduce mortality. The role of fluoroquinolones remains unclear. There have been no antimicrobial treatment trials for pediatric TBM. METHODS TBM-KIDS was a phase 2 open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (i) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, arm 1); (ii) high-dose rifampicin and levofloxacin (R30HZL, arm 2); or (iii) standard-dose rifampicin and ethambutol (R15HZE, arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL). RESULTS Of 2487 children prescreened, 79 were screened and 37 enrolled. Median age was 72 months; 49%, 43%, and 8% had stage I, II, and III disease, respectively. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in arms 1, 2, and 3, with 1 death (arm 1) and 6 early treatment discontinuations (4 in arm 1, 1 each in arms 2 and 3). By week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in arm 1 than arm 3 in fine motor, receptive language, and expressive language domains (P < .01). CONCLUSIONS In a pediatric TBM trial, functional outcomes were excellent overall. The trend toward higher frequency of adverse events but better neurocognitive outcomes in children receiving high-dose rifampicin requires confirmation in a larger trial. CLINICAL TRIALS REGISTRATION NCT02958709.
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Affiliation(s)
- Mandar S Paradkar
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India
| | - Bella Devaleenal D
- Department of Clinical Research, Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, India
| | - Tisungane Mvalo
- UNC Project Malawi, Lilongwe, Malawi,Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ana Arenivas
- Section of Neuropsychology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA
| | - Lisa Wolf
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Smita Nimkar
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India
| | - Sadaf Inamdar
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India
| | - Prathiksha Giridharan
- Department of Clinical Research, Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, India
| | | | - Aarti Kinikar
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Department of Pediatrics, BJ Government Medical College, Pune, India
| | - Chhaya Valvi
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Department of Pediatrics, BJ Government Medical College, Pune, India
| | - Saltanat Khwaja
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India
| | | | - Sarath Balaji
- Department of Clinical Research, Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, India
| | - Krishna Yadav Kattagoni
- Department of Clinical Research, Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, India
| | - Mythily Venkatesan
- Department of Clinical Research, Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, India
| | - Radojka Savic
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, USA
| | | | - Amita Gupta
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nikhil Gupte
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vidya Mave
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly E Dooley
- Correspondence: K. Dooley, Johns Hopkins University School of Medicine, 600 N Wolfe St, Osler 527, Baltimore, MD 21287 ()
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20
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Bogam P, Joshi A, Nagarkar S, Jain D, Gupte N, Shashidhara LS, Monteiro JM, Mave V. Burden of COVID-19 and case fatality rate in Pune, India: an analysis of the first and second wave of the pandemic. IJID Regions 2022; 2:74-81. [PMID: 35721428 PMCID: PMC8690685 DOI: 10.1016/j.ijregi.2021.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
In India, the second COVID-19 wave case burden was 1.5-fold higher than the first The case fatality rate (CFR) was highest among the >60 years age group The CFR sharply declined from the first to the second wave of the pandemic The highest increase in weekly cases was observed for the 30−44 years age group
Objective To assess trends in case incidence and fatality rate between the first and second waves, we analyzed programmatic COVID-19 data from Pune city, an epicenter of COVID-19 cases in India. Method The trends of cases incidence, time-to-death and case fatality rate (CFR) were analyzed. Poisson regression models adjusted for age and gender were used to determine the independent effect of pandemic waves on mortality. Results Of 465 192 COVID-19 cases, 162 182 (35%) were reported in the first wave and 4146 (2.5%) deaths, and 275 493 (59%) in the second wave and 3184 (1.1%) deaths (P<0.01). The overall CFR was 1.16 per 1000 person-days (PD), which declined from 1.80 per 1000 PD during the first wave to 0.77 per 1000 PD in the second. The risk of death was 1.49 times higher during the first wave (adjusted CFR ratio (aCFRR)1.49; 95% CI: 1.37–1.62) and 35% lower in the second wave (aCFRR 0.65; 95% CI: 0.59–0.70). Conclusion The burden of COVID-19 cases and deaths was more significant in the second wave; however, the CFR declined as the pandemic progressed. Nevertheless, investigating new therapies and implementing mass vaccination against COVID-19 are urgently needed.
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Affiliation(s)
- Prasad Bogam
- BJ Government Medical College-Johns Hopkins University Clinical Research Site (CRS), Pune, India
- Johns Hopkins India, Pune, India
- Corresponding author: Prasad Bogam, MPH, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, India-411001.
| | - Aparna Joshi
- Indian Institute of Science Education and Research, Pune, India
| | - Sanket Nagarkar
- Indian Institute of Science Education and Research, Pune, India
| | - Divyashri Jain
- BJ Government Medical College-Johns Hopkins University Clinical Research Site (CRS), Pune, India
| | - Nikhil Gupte
- BJ Government Medical College-Johns Hopkins University Clinical Research Site (CRS), Pune, India
- Johns Hopkins India, Pune, India
| | - LS Shashidhara
- Indian Institute of Science Education and Research, Pune, India
- Ashoka University, Sonipat, Haryana
- Pune Knowledge Cluster, Pune, India
| | - Joy Merwin Monteiro
- Indian Institute of Science Education and Research, Pune, India
- Pune Knowledge Cluster, Pune, India
- Co-Corresponding author: Joy Merwin Monteiro Ph.D., IISER campus, Baner, Pune 411012.
| | - Vidya Mave
- BJ Government Medical College-Johns Hopkins University Clinical Research Site (CRS), Pune, India
- Johns Hopkins India, Pune, India
- Pune Knowledge Cluster, Pune, India
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21
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Tornheim JA, Paradkar M, Zhao H, Kulkarni V, Pradhan N, Kinikar A, Kagal A, Gupte N, Mave V, Gupta A, Karakousis PC. The Kynurenine/Tryptophan Ratio Is a Sensitive Biomarker for the Diagnosis of Pediatric Tuberculosis Among Indian Children. Front Immunol 2022; 12:774043. [PMID: 35095848 PMCID: PMC8790563 DOI: 10.3389/fimmu.2021.774043] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives Pediatric tuberculosis (TB) remains difficult to diagnose. The plasma kynurenine to tryptophan ratio (K/T ratio) is a potential biomarker for TB diagnosis and treatment response but has not been assessed in children. Methods We performed a targeted diagnostic accuracy analysis of four biomarkers: kynurenine abundance, tryptophan abundance, the K/T ratio, and IDO-1 gene expression. Data were obtained from transcriptome and metabolome profiling of children with confirmed tuberculosis and age- and sex-matched uninfected household contacts of pulmonary tuberculosis patients. Each biomarker was assessed as a baseline diagnostic and in response to successful TB treatment. Results Despite non-significant between-group differences in unbiased analysis, the K/T ratio achieved an area under the receiver operator characteristic curve (AUC) of 0.667 and 81.5% sensitivity for TB diagnosis. Kynurenine, tryptophan, and IDO-1 demonstrated diagnostic AUCs of 0.667, 0.602, and 0.463, respectively. None of these biomarkers demonstrated high AUCs for treatment response. The AUC of the K/T ratio was lower than biomarkers identified in unbiased analysis, but improved sensitivity over existing commercial assays for pediatric TB diagnosis. Conclusions Plasma kynurenine and the K/T ratio may be useful biomarkers for pediatric TB. Ongoing studies in geographically diverse populations will determine optimal use of these biomarkers worldwide.
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Affiliation(s)
- Jeffrey A Tornheim
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Center for Clinical Global Health Education, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Henry Zhao
- Johns Hopkins University, Baltimore, MD, United States
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Neeta Pradhan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Aarti Kinikar
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Anju Kagal
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Nikhil Gupte
- Center for Clinical Global Health Education, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Vidya Mave
- Center for Clinical Global Health Education, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Amita Gupta
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Center for Clinical Global Health Education, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Petros C Karakousis
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Center for Clinical Global Health Education, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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22
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Mave V, Chen L, Ranganathan UD, Kadam D, Vishwanathan V, Lokhande R, S SK, Kagal A, Pradhan N, Shivakumar SVBY, Paradkar MS, Deshmukh S, Tornheim JA, Kornfeld H, Farhat M, Gupta A, Padmapriyadarsini C, Gupte N, Golub JE, Mathema B, Kreiswirth BN. Whole Genome Sequencing Assessing Impact of Diabetes Mellitus on Tuberculosis Mutations and Type of Recurrence in India. Clin Infect Dis 2022; 75:768-776. [PMID: 34984435 PMCID: PMC9477453 DOI: 10.1093/cid/ciab1067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Evidence describing the impact of diabetes mellitus (DM) on the recurrence and mutation rate of Mycobacterium tuberculosis (Mtb) is limited. METHODS This study was nested in 3 cohort studies of tuberculosis (TB) patients with and without DM in India. Paired Mtb isolates recovered at baseline and treatment failure/recurrence underwent whole genome sequencing. We compared acquisition of single-nucleotide polymorphisms (SNPs), TB drug resistance mutations, and type of recurrence (endogenous reactivation [<8 SNPs] or exogenous reinfection [≥8 SNPs]) by DM status. RESULTS Of 1633 enrolled in the 3 parent cohorts, 236 (14.5%) had microbiologically confirmed TB treatment failure/recurrence; 76 Mtb isolate pairs were available for sequencing (22 in TB-DM and 54 in TB-only). The SNP acquisition rate was overall was 0.43 (95% confidence interval [CI], .25-.64) per 1 person-year (PY); 0.77 (95% CI, .40-1.35) per 1 PY, and 0.44 (95% CI, .19-.86) per 1 PY at treatment failure and recurrence, respectively. Significant difference in SNP rates by DM status was seen at recurrence (0.21 [95% CI, .04-.61]) per 1 PY for TB-only vs 1.28 (95% CI, .41-2.98) per 1 PY for TB-DM; P = .02). No significant difference in SNP rates by DM status was observed at treatment failure. Acquired TB drug resistance was seen in 4 of 18 (22%) in TB-DM vs 4 of 45 (9%) in TB-only (P = .21). Thirteen (17%) participants had exogenous reinfection; the reinfection rate at recurrence was 25% (3/12) for TB-DM vs 17% (4/24) in TB-only (P = .66). CONCLUSIONS Considerable intrahost Mtb mutation rates were present at recurrence among patients with DM in India. One-fourth of patients with DM had exogenous reinfection at recurrence.
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Affiliation(s)
- Vidya Mave
- Correspondence: V. Mave, Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Jai Prakash Narayan Road, First Floor, Pune, Maharashtra, India 411001 ()
| | - Liang Chen
- Hackensack Meridian Health, Center for Discovery and Innovation, Nutley, New Jersey, USA
| | | | - Dileep Kadam
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | | | - Rahul Lokhande
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Siva Kumar S
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Anju Kagal
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Neeta N Pradhan
- Byramjee-Jeejeebhoy Medical College–Johns Hopkins University Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India
| | | | - Mandar S Paradkar
- Byramjee-Jeejeebhoy Medical College–Johns Hopkins University Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India
| | - Sona Deshmukh
- Byramjee-Jeejeebhoy Medical College–Johns Hopkins University Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India
| | | | | | - Maha Farhat
- Harvard Medical School, Boston, Massachusetts, USA
| | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Nikhil Gupte
- Byramjee-Jeejeebhoy Medical College–Johns Hopkins University Clinical Research Site, Pune, India,Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Johns Hopkins India, Pune, India
| | - Jonathan E Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Barry N Kreiswirth
- Hackensack Meridian Health, Center for Discovery and Innovation, Nutley, New Jersey, USA
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23
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Shivakoti R, Newman JW, Hanna LE, Queiroz ATL, Borkowski K, Gupte AN, Paradkar M, Satyamurthi P, Kulkarni V, Selva M, Pradhan N, Shivakumar SVBY, Natarajan S, Karunaianantham R, Gupte N, Thiruvengadam K, Fiehn O, Bharadwaj R, Kagal A, Gaikwad S, Sangle S, Golub JE, Andrade BB, Mave V, Gupta A, Padmapriyadarsini C. Host lipidome and tuberculosis treatment failure. Eur Respir J 2022; 59:2004532. [PMID: 34375300 PMCID: PMC9625841 DOI: 10.1183/13993003.04532-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/15/2020] [Accepted: 05/24/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Host lipids play important roles in tuberculosis (TB) pathogenesis. Whether host lipids at TB treatment initiation (baseline) affect subsequent treatment outcomes has not been well characterised. We used unbiased lipidomics to study the prospective association of host lipids with TB treatment failure. METHODS A case-control study (n=192), nested within a prospective cohort study, was used to investigate the association of baseline plasma lipids with TB treatment failure among adults with pulmonary TB. Cases (n=46) were defined as TB treatment failure, while controls (n=146) were those without failure. Complex lipids and inflammatory lipid mediators were measured using liquid chromatography mass spectrometry techniques. Adjusted least-square regression was used to assess differences in groups. In addition, machine learning identified lipids with highest area under the curve (AUC) to classify cases and controls. RESULTS Baseline levels of 32 lipids differed between controls and those with treatment failure after false discovery rate adjustment. Treatment failure was associated with lower baseline levels of cholesteryl esters and oxylipin, and higher baseline levels of ceramides and triglycerides compared to controls. Two cholesteryl ester lipids combined in a unique classifier model provided an AUC of 0.79 (95% CI 0.65-0.93) in the test dataset for prediction of TB treatment failure. CONCLUSIONS We identified lipids, some with known roles in TB pathogenesis, associated with TB treatment failure. In addition, a lipid signature with prognostic accuracy for TB treatment failure was identified. These lipids could be potential targets for risk-stratification, adjunct therapy and treatment monitoring.
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Affiliation(s)
- Rupak Shivakoti
- Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Dept of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - John W Newman
- Obesity and Metabolism Research Unit, Western Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Davis, CA, USA
- Dept of Nutrition, University of California, Davis, CA, USA
- West Coast Metabolomics Center, University of California, Davis, CA, USA
| | | | - Artur T L Queiroz
- Instituto Goncalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research, Salvador, Brazil
| | - Kamil Borkowski
- West Coast Metabolomics Center, University of California, Davis, CA, USA
| | - Akshay N Gupte
- Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mandar Paradkar
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | | | - Vandana Kulkarni
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Murugesh Selva
- National Institute for Research in Tuberculosis, Chennai, India
| | - Neeta Pradhan
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | | | | | | | - Nikhil Gupte
- Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | | | - Oliver Fiehn
- West Coast Metabolomics Center, University of California, Davis, CA, USA
| | - Renu Bharadwaj
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Anju Kagal
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Sanjay Gaikwad
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | | | - Jonathan E Golub
- Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruno B Andrade
- Instituto Goncalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Curso de Medicina, Faculdade de Tecnologia e Ciências, Salvador, Brazil
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate International Universities, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Vidya Mave
- Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Amita Gupta
- Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Equal contribution
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24
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Tornheim JA, Udwadia ZF, Arora PR, Gajjar I, Gupte N, Sharma S, Karane M, Sawant N, Kharat N, Blum AJ, Shivakumar SVBY, Mullerpattan JB, Pinto LM, Ashavaid TF, Gupta A, Rodrigues C. Cycloserine did not increase depression incidence or severity at standard dosing for MDR-TB. Eur Respir J 2021; 59:13993003.02511-2021. [PMID: 34949698 PMCID: PMC8943271 DOI: 10.1183/13993003.02511-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022]
Abstract
In 2018 cycloserine was elevated to World Health Organization (WHO) group B status for multidrug-resistant tuberculosis (MDR-TB), and is recommended in longer MDR-TB treatment regimens [1]. Inclusion of cycloserine is associated with improved MDR-TB treatment success and reduced mortality, but is limited by treatment-associated depression, psychosis and neuropathy, forcing 9% of patients to stop therapy [1–3]. Cycloserine also demonstrates wide interindividual pharmacokinetic variation, with significant food and drug interactions, leaving nearly half of patients with inappropriate drug levels [4, 5]. Optimal dosing is unknown [6], but modelling studies suggest doses from 250 mg to 750 mg twice daily, with 500 mg twice daily for paucibacillary disease and 750 mg twice daily for cavitary pulmonary disease [7]. Therefore, clinicians must balance the known benefits of cycloserine with the dearth of susceptibility- and drug-monitoring capacity and the spectre of treatment-limiting side-effects. To evaluate the impact of cycloserine prescription and dose on incident depression during MDR-TB treatment, we analysed longitudinal cohort data from India. In a longitudinal cohort of MDR-TB patients receiving individualised, DST-based treatment, neither the inclusion of cycloserine in a multidrug regimen nor the dose used (up to 750 mg daily) significantly increased incidence of depression during treatmenthttps://bit.ly/3GtQmOH
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Affiliation(s)
- Jeffrey A Tornheim
- Center for Clinical Global Health Education, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zarir F Udwadia
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Prerna R Arora
- Department of Lab Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Ishita Gajjar
- Department of Lab Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Nikhil Gupte
- Center for Clinical Global Health Education, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University - India office (CCGHE), Pune, Maharashtra, India
| | - Samridhi Sharma
- Department of Lab Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Megha Karane
- Department of Lab Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Namrata Sawant
- Department of Lab Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Nisha Kharat
- Department of Lab Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | | | | | - Jai B Mullerpattan
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Lancelot M Pinto
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Tester F Ashavaid
- Department of Lab Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Amita Gupta
- Center for Clinical Global Health Education, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Heath, Baltimore, MD, USA
| | - Camilla Rodrigues
- Department of Microbiology, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
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25
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Tornheim JA, Udwadia ZF, Arora PR, Gajjar I, Sharma S, Karane M, Sawant N, Kharat N, Blum AJ, Shivakumar SVBY, Gupte AN, Gupte N, Mullerpattan JB, Pinto LM, Ashavaid TF, Gupta A, Rodrigues C. Increased Moxifloxacin Dosing Among Patients With Multidrug-Resistant Tuberculosis With Low-Level Resistance to Moxifloxacin Did Not Improve Treatment Outcomes in a Tertiary Care Center in Mumbai, India. Open Forum Infect Dis 2021; 9:ofab615. [PMID: 35097152 PMCID: PMC8794589 DOI: 10.1093/ofid/ofab615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/01/2021] [Indexed: 12/02/2022] Open
Abstract
Background Mycobacterium tuberculosis (Mtb) strains resistant to isoniazid and rifampin (multidrug-resistant tuberculosis [MDR-TB]) are increasingly reported worldwide, requiring renewed focus on the nuances of drug resistance. Patients with low-level moxifloxacin resistance may benefit from higher doses, but limited clinical data on this strategy are available. Methods We conducted a 5-year observational cohort study of MDR-TB patients at a tertiary care center in India. Participants with Mtb isolates resistant to isoniazid, rifampin, and moxifloxacin (at the 0.5 µg/mL threshold) were analyzed according to receipt of high-dose moxifloxacin (600 mg daily) as part of a susceptibility-guided treatment regimen. Univariable and multivariable Cox proportional hazard models assessed the relationship between high-dose moxifloxacin and unfavorable treatment outcomes. Results Of 354 participants with MDR-TB resistant to moxifloxacin, 291 (82.2%) received high-dose moxifloxacin. The majority experienced good treatment outcomes (200 [56.5%]), which was similar between groups (56.7% vs 54.0%, P = .74). Unfavorable outcomes were associated with greater extent of radiographic disease, lower initial body mass index, and concurrent treatment with fewer drugs with confirmed phenotypic susceptibility. Treatment with high-dose moxifloxacin was not associated with improved outcomes in either unadjusted (hazard ratio [HR], 1.2 [95% confidence interval {CI}, .6–2.4]) or adjusted (HR, 0.8 [95% CI, .5–1.4]) models but was associated with joint pain (HR, 3.2 [95% CI, 1.2–8.8]). Conclusions In a large observational cohort, adding high-dose (600 mg) moxifloxacin to a drug susceptibility test–based treatment regimen for MDR-TB was associated with increased treatment-associated side effects without improving overall outcomes and should be avoided for empiric treatment of moxifloxacin-resistant MDR-TB.
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Affiliation(s)
- Jeffrey A Tornheim
- Center for Clinical Global Health Education, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zarir F Udwadia
- Department of Respiratory Medicine, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Prerna R Arora
- Department of Laboratory Medicine, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Ishita Gajjar
- Department of Laboratory Medicine, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Samridhi Sharma
- Department of Laboratory Medicine, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Megha Karane
- Department of Laboratory Medicine, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Namrata Sawant
- Department of Laboratory Medicine, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Nisha Kharat
- Department of Laboratory Medicine, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Alexander J Blum
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Akshay N Gupte
- Center for Clinical Global Health Education, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nikhil Gupte
- Center for Clinical Global Health Education, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins University–India Office (Center for Clinical Global Health Education), Pune, Maharashtra, India
| | - Jai B Mullerpattan
- Department of Respiratory Medicine, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Lancelot M Pinto
- Department of Respiratory Medicine, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Tester F Ashavaid
- Department of Laboratory Medicine, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Amita Gupta
- Center for Clinical Global Health Education, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Camilla Rodrigues
- Department of Microbiology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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26
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Dixit A, Kagal A, Ektefaie Y, Freschi L, Lokhande R, Groeschel M, Tornheim JA, Gupte N, Pradhan NN, Kadam D, Gupta A, Golub J, Farhat M, Mave V. 1397. Modern Lineages of Mycobacterium tuberculosis Were Recently Introduced in Western India and Demonstrate Increased Transmissibility. Open Forum Infect Dis 2021. [PMCID: PMC8643855 DOI: 10.1093/ofid/ofab466.1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Mycobacterium tuberculosis (Mtb) transmissibility may vary between lineages (or variants) and this may contribute to the slow decline of tuberculosis incidence. The objective of our study was to compare transmissibility across four major lineages (L1-4) of Mtb in Pune, India. Methods We performed whole-genome sequencing (WGS) of Mtb isolated from sputum culture of adult patients with pulmonary TB. We performed genotypic susceptibility testing for both first- and second-line drugs using a previously validated random forest predictor. We identified single nucleotide polymorphisms and generated a multiple sequence alignment excluding drug resistance conferring mutations to avoid skewing the phylogeny due to convergent evolution in these regions. We used Bayesian molecular dating to generate phylogenies and compared tree characteristics using a two-sample Kolmogorov-Smirnov (KS) test. Results Of the 642 isolates from distinct study participants that underwent WGS, 612 met quality criteria. The median age of participants was 31 years (range 18-74), the majority were male (64.7%) and sputum smear-positive (83.3%), and 6.7% had co-infection with HIV (Table 1). There was no significant difference in baseline characteristics between lineages. The majority of isolates belonged to L3 (44.6%). The majority (61.1%) of multidrug-resistant (MDR, resistant to isoniazid and rifampin) isolates belonged to L2. In phylogenetic analysis, we found evidence of higher transmissibility of L2 as indicated by shorter branch lengths (i.e., less time had elapsed between transmission and sampling) and more genetic similarity (smaller pairwise single nucleotide polymorphism [SNP] distances) among L2 isolates as compared to other lineages (Figure 1). Branching times for L2 and L4 were smaller than L1 and L3 indicating recent introduction into the region (p < 0.001 [KS test]). ![]()
Figure 1: Lineage-wise distribution of A) phylogenetic tree branch lengths (log) and B) pairwise single nucleotide polymorphism (SNP) distance, using 612 tuberculosis isolates from Pune, India. P values calculated using two-sample Kolmogorov-Smirnov test. ![]()
Table 1: Demographic characteristics of study participants included in the study, by lineage. Conclusion Modern Mtb lineages (L2 and L4) were relatively recently introduced in western India, as compared to older lineages (L1 and L3), with the more drug-resistant L2 showing higher transmissibility. These findings highlight the need for early detection and treatment initiation to interrupt transmission with important implications for antimicrobial stewardship and heightened surveillance of TB resistance rates. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Avika Dixit
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anju Kagal
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Pune, Maharashtra, India
| | | | | | - Rahul Lokhande
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Pune, Maharashtra, India
| | | | | | - Nikhil Gupte
- Johns Hopkins University, Pune, Maharashtra, India
| | | | - Deelip Kadam
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Pune, Maharashtra, India
| | | | | | - Maha Farhat
- Harvard Medical School, Boston, Massachusetts
| | - Vidya Mave
- Johns Hopkins University, Pune, Maharashtra, India
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Gupte AN, Kumar P, Araújo-Pereira M, Kulkarni V, Paradkar M, Pradhan N, Menon P, Chandrasekaran PD, Hanna LE, Yogendra Shivakumar SVB, Rockwood N, Du Bruyn E, Karyakarte R, Gaikwad S, Bollinger R, Golub J, Gupte N, Viswanathan V, Wilkinson RJ, Mave V, Babu S, Kornfeld H, Andrade BB, Gupta A. Baseline IL-6 is a biomarker for unfavorable tuberculosis treatment outcomes: a multi-site discovery and validation study. Eur Respir J 2021; 59:13993003.00905-2021. [PMID: 34711538 PMCID: PMC7612881 DOI: 10.1183/13993003.00905-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022]
Abstract
Background Biomarkers of unfavorable tuberculosis treatment outcomes are needed to accelerate new drug and regimen development. Whether plasma cytokine levels can predict unfavorable tuberculosis treatment outcomes is unclear. Methods We identified and internally validated the association between 20 a-priori selected plasma inflammatory markers and unfavorable treatment outcomes of failure, recurrence and all-cause mortality among adults with drug-sensitive pulmonary tuberculosis in India. We externally validated these findings in two independent cohorts of predominantly diabetic and HIV coinfected tuberculosis patients in India and South Africa, respectively. Results Pre-treatment IFN-γ, IL-13 and IL-6 were associated with treatment failure in the discovery analysis. Internal validation confirmed higher pre-treatment IL-6 concentrations among failure cases compared to controls. External validation among predominantly diabetic tuberculosis patients found an association between pre-treatment IL-6 concentrations and subsequent recurrence and death. Similarly, external validation among predominantly HIV coinfected tuberculosis patients found an association between pre-treatment IL-6 concentrations and subsequent treatment failure and death. In a pooled analysis of 363 tuberculosis cases from the Indian and South African validation cohorts, high pre-treatment IL-6 concentrations were associated with higher risk of failure (adjusted odds ratio [aOR]=2.16, 95%CI 1.08-4.33, p=0.02), recurrence (aOR=5.36, 95%CI 2.48-11.57, p<0.001) and death (aOR=4.62, 95%CI 1.95-10.95, p<0.001). Adding baseline IL-6 to a risk-prediction model comprising of low BMI, high smear grade and cavitation improved model performance by 15 percent (C-statistic of 0.66 versus 0.76, p=0.02). Conclusion Pre-treatment IL-6 is a biomarker for unfavorable tuberculosis treatment outcomes. Future studies should identify optimal IL-6 concentrations for point-of-care risk prediction.
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Affiliation(s)
- Akshay N Gupte
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA .,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Pavan Kumar
- National Institute for Research in Tuberculosis, Chennai, India
| | - Mariana Araújo-Pereira
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Vandana Kulkarni
- Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA.,Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins India Private Limited, Pune, India
| | - Mandar Paradkar
- Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA.,Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins India Private Limited, Pune, India
| | - Neeta Pradhan
- Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA.,Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins India Private Limited, Pune, India
| | - Pradeep Menon
- National Institute for Research in Tuberculosis, Chennai, India
| | | | | | | | - Neesha Rockwood
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa.,Department of Microbiology, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka.,Department of Infectious Diseases, Imperial College London, United Kingdom
| | - Elsa Du Bruyn
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa.,Department of Infectious Diseases, University of Cape Town, Observatory, South Africa
| | - Rajesh Karyakarte
- Department of Microbiology, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Sanjay Gaikwad
- Department of Pulmonary Medicine, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Robert Bollinger
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jonathan Golub
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Tuberculosis Research, Johns Hopkins University, Baltimore, USA
| | - Nikhil Gupte
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Robert J Wilkinson
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa.,Department of Infectious Diseases, Imperial College London, United Kingdom.,Department of Infectious Diseases, University of Cape Town, Observatory, South Africa.,The Francis Crick Institute, London, UK
| | - Vidya Mave
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Subash Babu
- National Institutes of Health - National Institute for Research in Tuberculosis - International Center for Excellence in Research, Chennai, India
| | - Hardy Kornfeld
- Division of Pulmonary Medicine, University of Massachusetts Medical School, Worcester, USA
| | - Bruno B Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Amita Gupta
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
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28
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Bhosale R, Alexander M, Deshpande P, Kulkarni V, Gupte N, Gupta A, Mathad J. Stages of pregnancy and HIV affect diagnosis of tuberculosis infection and Mycobacterium tuberculosis (MTB)-induced immune response: Findings from PRACHITi, a cohort study in Pune, India. Int J Infect Dis 2021; 112:205-211. [PMID: 34517050 PMCID: PMC8715310 DOI: 10.1016/j.ijid.2021.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/21/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Accurate tuberculosis infection (TBI) tests are critical for pregnant women, especially those with HIV, who have a high risk of TB disease. METHODS We enrolled interferon gamma release assay (IGRA)+ pregnant women with and without HIV in a longitudinal study, followed up at delivery and 6 months postpartum. Tuberculin skin test (TST) and IGRA were compared by HIV status at each timepoint. RESULTS Of 165 enrolled IGRA+ pregnant women: 35 (21%) had HIV and were on antiretroviral therapy with median CD4 of 476 (IQR 399-586). Compared to antepartum, significantly fewer women remained IGRA+ at delivery [HIV+ n=21/35 (62%, p=0.009); HIV- n=100/130 (77%, p=0.002)] and postpartum [HIV+ n=30/35 (87%, p=0.03); HIV- n=116/130 (89%, p=0.01)]. IGRA/TST discordance was high in pregnant women (HIV+: 51%; HIV-: 25%). Median IFN-γ was lowest for all women at delivery; significantly lower in women with HIV at all timepoints compared to women without HIV. TB incidence was 50/ 1000 person-years and 18/1000 person-years among women with and without HIV respectively. CONCLUSIONS Pregnancy affects TBI test results and reduces IFN-γ response to M. tuberculosis stimulation. Despite adequate CD4 counts, women with HIV express less IFN-γ than women without HIV, which may explain the high TB incidence in postpartum women with HIV.
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Affiliation(s)
- Ramesh Bhosale
- Byramjee Jeejeebhoy Government Medical College, Jai Prakash Narayan Rd. Pune, 411001, Maharashtra, India
| | - Mallika Alexander
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Trials Unit, 1st Floor, ENT department, Jai Prakash Narayan Rd. Pune, 411001, Maharashtra, India.
| | - Prasad Deshpande
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Trials Unit, 1st Floor, ENT department, Jai Prakash Narayan Rd. Pune, 411001, Maharashtra, India
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Trials Unit, 1st Floor, ENT department, Jai Prakash Narayan Rd. Pune, 411001, Maharashtra, India
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Trials Unit, 1st Floor, ENT department, Jai Prakash Narayan Rd. Pune, 411001, Maharashtra, India; Johns Hopkins School of Medicine, 600 N. Wolfe Street, Phipps 540, Baltimore, MD 1287, USA
| | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Trials Unit, 1st Floor, ENT department, Jai Prakash Narayan Rd. Pune, 411001, Maharashtra, India; Johns Hopkins School of Medicine, 600 N. Wolfe Street, Phipps 540, Baltimore, MD 1287, USA
| | - Jyoti Mathad
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Trials Unit, 1st Floor, ENT department, Jai Prakash Narayan Rd. Pune, 411001, Maharashtra, India; Weill Cornell Medical College, 402 E. 67th Street, 2nd floor, New York, NY 10065, USA
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29
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Nimkar S, Joshi S, Kinikar A, Valvi C, Devaleenal DB, Thakur K, Bendre M, Khwaja S, Ithape M, Kattagoni K, Paradkar M, Gupte N, Gupta A, Suryavanshi N, Mave V, Dooley KE, Arenivas A. Mullen Scales of Early Learning Adaptation for Assessment of Indian Children and Application to Tuberculous Meningitis. J Trop Pediatr 2021; 67:fmaa034. [PMID: 32620972 PMCID: PMC8496186 DOI: 10.1093/tropej/fmaa034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Tuberculous meningitis (TBM) results in significant morbidity and mortality among children worldwide. Associated neurocognitive complications are common but not well characterized. The Mullen Scales of Early Learning (MSEL), a well-established measure for assessment of neurodevelopment, has not yet been adapted for use in India. This study's goal was to adapt the MSEL for local language and culture to assess neurocognition among children in India, and apply the adapted measure for assessment of children with TBM. METHODS Administration of MSEL domains was culturally adapted. Robust translation procedures for instructions took place for three local languages: Marathi, Hindi and Tamil. Multilingual staff compared instructions against the original version for accuracy. The MSEL stimuli and instructions were reviewed by psychologists and pediatricians in India to identify items concerning for cultural bias. RESULTS MSEL stimuli unfamiliar to children in this setting were identified and modified within Visual Reception, Fine-Motor, Receptive Language and Expressive Language Scales. Item category was maintained for adaptations of items visually or linguistically different from those observed in daily life. Adjusted items were administered to six typically developing children to determine modification utility. Two children diagnosed with confirmed TBM (ages 11 and 29 months) were evaluated with the adapted MSEL before receiving study medications. Skills were below age-expectation across visual reception, fine motor and expressive language domains. CONCLUSIONS This is the first study to assess children with TBM using the MSEL adapted for use in India. Future studies in larger groups of Indian children are warranted to validate the adapted measure.
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Affiliation(s)
- Smita Nimkar
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
- Department of Health and Biomedical Sciences, Symbiosis International (Deemed) University, Lavale, Pune, India
| | - Suvarna Joshi
- Department of Health and Biomedical Sciences, Symbiosis International (Deemed) University, Lavale, Pune, India
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Aarti Kinikar
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Chhaya Valvi
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - D Bella Devaleenal
- Department of Clinical Research, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Kiran Thakur
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Manjushree Bendre
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
| | - Saltanat Khwaja
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
| | - Mahesh Ithape
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
| | - Krishna Kattagoni
- Department of Clinical Research, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Mandar Paradkar
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
| | - Nikhil Gupte
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amita Gupta
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nishi Suryavanshi
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
| | - Vidya Mave
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly E Dooley
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ana Arenivas
- Department of Rehabilitation Psychology and Neuropsychology, The Institute for Rehabilitation and Research (TIRR) Memorial Hermann, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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30
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Abulfathi AA, de Jager V, van Brakel E, Reuter H, Gupte N, Vanker N, Barnes GL, Nuermberger E, Dorman SE, Diacon AH, Dooley KE, Svensson EM. The Population Pharmacokinetics of Meropenem in Adult Patients With Rifampicin-Sensitive Pulmonary Tuberculosis. Front Pharmacol 2021; 12:637618. [PMID: 34267655 PMCID: PMC8275874 DOI: 10.3389/fphar.2021.637618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Meropenem is being investigated for repurposing as an anti-tuberculosis drug. This study aimed to develop a meropenem population pharmacokinetics model in patients with pulmonary tuberculosis and identify covariates explaining inter-individual variability. Methods: Patients were randomized to one of four treatment groups: meropenem 2 g three times daily plus oral rifampicin 20 mg/kg once daily, meropenem 2 g three times daily, meropenem 1 g three times daily, and meropenem 3 g once daily. Meropenem was administered by intravenous infusion over 0.5–1 h. All patients also received oral amoxicillin/clavulanate together with each meropenem dose, and treatments continued daily for 14 days. Intensive plasma pharmacokinetics sampling over 8 h was conducted on the 14th day of the study. Nonlinear mixed-effects modeling was used for data analysis. The best model was chosen based on likelihood metrics, goodness-of-fit plots, and parsimony. Covariates were tested stepwise. Results: A total of 404 concentration measurements from 49 patients were included in the analysis. A two-compartment model parameterized with clearance (CL), inter-compartmental clearance (Q), and central (V1) and peripheral (V2) volumes of distribution fitted the data well. Typical values of CL, Q, V1, and V2 were 11.8 L/h, 3.26 L/h, 14.2 L, and 3.12 L, respectively. The relative standard errors of the parameter estimates ranged from 3.8 to 35.4%. The covariate relations included in the final model were creatinine clearance on CL and allometric scaling with body weight on all disposition parameters. An effect of age on CL as previously reported could not be identified. Conclusion: A two-compartment model described meropenem population pharmacokinetics in patients with pulmonary tuberculosis well. Covariates found to improve model fit were creatinine clearance and body weight but not rifampicin treatment. The final model will be used for an integrated pharmacokinetics/pharmacodynamics analysis linking meropenem exposure to early bactericidal activity.
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Affiliation(s)
- Ahmed A Abulfathi
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.,Department of Clinical Pharmacology and Therapeutics, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | | | | | - Helmuth Reuter
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Nikhil Gupte
- Department of Medicine, Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, United States
| | | | - Grace L Barnes
- Department of Medicine, Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, United States
| | - Eric Nuermberger
- Department of Medicine, Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, United States
| | - Susan E Dorman
- Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Andreas H Diacon
- Task Applied Science, Bellville, South Africa.,Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Kelly E Dooley
- Divisions of Clinical Pharmacology and Infectious Diseases, Department of Medicine, Johns Hopkins University Center for Tuberculosis Research, Baltimore, MD, United States
| | - Elin M Svensson
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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31
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Krishnan S, Queiroz ATL, Gupta A, Gupte N, Bisson GP, Kumwenda J, Naidoo K, Mohapi L, Mave V, Mngqibisa R, Lama JR, Hosseinipour MC, Andrade BB, Karakousis PC. Integrative Multi-Omics Reveals Serum Markers of Tuberculosis in Advanced HIV. Front Immunol 2021; 12:676980. [PMID: 34168648 PMCID: PMC8217878 DOI: 10.3389/fimmu.2021.676980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
Tuberculosis (TB) accounts for disproportionate morbidity and mortality among persons living with HIV (PLWH). Conventional methods of TB diagnosis, including smear microscopy and Xpert MTB/RIF, have lower sensitivity in PLWH. Novel high-throughput approaches, such as miRNAomics and metabolomics, may advance our ability to recognize subclinical and difficult-to-diagnose TB, especially in very advanced HIV. We conducted a case-control study leveraging REMEMBER, a multi-country, open-label randomized controlled trial comparing 4-drug empiric standard TB treatment with isoniazid preventive therapy in PLWH initiating antiretroviral therapy (ART) with CD4 cell counts <50 cells/μL. Twenty-three cases of incident TB were site-matched with 32 controls to identify microRNAs (miRNAs), metabolites, and cytokines/chemokines, associated with the development of newly diagnosed TB in PLWH. Differentially expressed miRNA analysis revealed 11 altered miRNAs with a fold change higher than 1.4 or lower than -1.4 in cases relative to controls (p<0.05). Our analysis revealed no differentially abundant metabolites between cases and controls. We found higher TNFα and IP-10/CXCL10 in cases (p=0.011, p=0.0005), and higher MDC/CCL22 in controls (p=0.0072). A decision-tree algorithm identified gamma-glutamylthreonine and hsa-miR-215-5p as the optimal variables to classify incident TB cases (AUC 0.965; 95% CI 0.925-1.000). hsa-miR-215-5p, which targets genes in the TGF-β signaling pathway, was downregulated in cases. Gamma-glutamylthreonine, a breakdown product of protein catabolism, was less abundant in cases. To our knowledge, this is one of the first uses of a multi-omics approach to identify incident TB in severely immunosuppressed PLWH.
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Affiliation(s)
- Sonya Krishnan
- Center for Clinical Global Health Education and Center for Tuberculosis Research, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Artur T. L. Queiroz
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
| | - Amita Gupta
- Center for Clinical Global Health Education and Center for Tuberculosis Research, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Nikhil Gupte
- Center for Clinical Global Health Education and Center for Tuberculosis Research, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Gregory P. Bisson
- Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | | | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- South African Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Lerato Mohapi
- Soweto ACTG CRS, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Rosie Mngqibisa
- Durban International Clinical Research Site, Enhancing Care Foundation, Durban, South Africa
| | | | - Mina C. Hosseinipour
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Bruno B. Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Curso de Medicina, Faculdade de Tecnologia e Ciências (FTC), Salvador, Brazil
- Curso de Medicina, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Petros C. Karakousis
- Center for Clinical Global Health Education and Center for Tuberculosis Research, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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32
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Girish S, Kinikar A, Pardesh G, Shelke S, Basavaraj A, Chandanwale A, Kadam D, Josh S, Dhumal G, Lokhande N, Deluca A, Gupte N, Gupta A, Bollinger RC, Mave V. Utility of the Interferon-Gamma Release Assay for Latent Tuberculosis Infection Screening among Indian Health-Care Workers. Indian J Community Med 2021; 46:281-284. [PMID: 34321742 PMCID: PMC8281831 DOI: 10.4103/ijcm.ijcm_761_20] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/31/2021] [Indexed: 11/04/2022] Open
Abstract
Background The utility of interferon-gamma release assays (IGRAs) for latent tuberculosis infection (LTBI) screening among health-care workers (HCWs) in low- and middle-income countries (LMICs) remains unclear. Methods This was a prospective cohort study among HCW trainees undergoing annual LTBI screening via tuberculin skin test (TST) and QuantiFERON® TB Gold Test-in-tube (QFT-GIT) in Pune, India. TST induration ≥ 10 mm and QFT-GIT ≥ 0.35 IU/ml were considered positive. Test concordance was evaluated at entry among the entire cohort and at 1 year among baseline TST-negative participants with follow-up testing. Overall test agreement was evaluated at both timepoints using the kappa statistic: fair (k < 0.40), good (0.41 ≥ k ≤0.60), or strong (k > 0.60). Results Of 200 participants, prevalent LTBI was detected in 42 (21%) via TST and 45 (23%) via QFT-GIT; QFT-GIT was positive in 27/42 (64%) TST-positive and 18/158 (11%) TST-negative trainees. Annual TST conversion was 28% (40/142) and included 11 trainees with baseline TST-/IGRA+; QFT-GIT was positive in 17/40 (43%) TST-positive and 5/102 (5%) TST-negative trainees. Overall test concordance was 84% (k = 0.52; 95% confidence interval [CI]: 0.38-0.66) and 80% (k = 0.44; 95% CI: 0.29-0.59) at baseline and 12 months, respectively. Conclusions We observed good overall agreement between TST and QFT-GIT, and QFT-GIT detected additional LTBI cases among TST-negative trainees with possible early detection of LTBI conversion. Overall, our results support the use of IGRA for annual LTBI screening among HCWs in a high burden LMIC setting.
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Affiliation(s)
- Sunita Girish
- Department of Biochemistry, Byramjee Jeejeebhoy Government Medical College-Sassoon General Hospital, Pune, Maharashtra, India
| | - Aarti Kinikar
- Department of Paediatrics, Byramjee Jeejeebhoy Government Medical College-Sassoon General Hospital, Pune, Maharashtra, India
| | - Geeta Pardesh
- Department of Community Medicine, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sangita Shelke
- Department of Community Medicine, Byramjee Jeejeebhoy Government Medical College-Sassoon General Hospital, Pune, Maharashtra, India
| | - Anita Basavaraj
- Department of Medicine, Government Medical College, Miraj, Maharashtra, India
| | - Ajay Chandanwale
- Department of Orthopaedics, Byramjee Jeejeebhoy Government Medical College-Sassoon General Hospital, Pune, Maharashtra, India
| | - Dileep Kadam
- Department of Medicine, Smt.Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Samir Josh
- ENT, Byramjee Jeejeebhoy Government Medical College-Sassoon General Hospital, Pune, Maharashtra, India
| | - Gauri Dhumal
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Nilima Lokhande
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Andrea Deluca
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India.,Medicine and Public Health, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore
| | - Robert C Bollinger
- Medicine, Public Health, and Nursing, Division of Infectious Diseases, Johns Hopkins University School of Medicine, MD, USA
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India.,Medicine and Public Health, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore
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33
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Mave V, Kadam D, Gaikwad S, Kinikar A, Aguilar D, Chavan A, Paradkar M, Yogendra SVB, Bharadwaj R, Kagal A, Suryavanshi N, Golub J, Kulkarni V, Dooley KE, Gupta A, Bacchetti P, Gerona R, Gupte N, Gandhi M. Measuring TB drug levels in the hair in adults and children to monitor drug exposure and outcomes. Int J Tuberc Lung Dis 2021; 25:52-60. [PMID: 33384045 DOI: 10.5588/ijtld.20.0574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
INTRODUCTION: Testing for anti-TB drugs in small hair samples may serve as a non-invasive tool to measure cumulative drug exposure and/or adherence, as these determine treatment success. We aimed to assess how well hair assays of TB drugs predict TB treatment outcomes.METHODS: A small thatch of hair, ~30 strands, was cut from the occipital region in adults and children from a prospective TB cohort in India. Isoniazid (INH), acetyl-INH and pyrazinamide (PZA) were extracted from the hair samples and quantified using liquid-chromatography-tandem mass spectrometry. The relationship between drug concentrations in hair and time to unfavourable outcomes was assessed using Cox-proportional hazards regression models.RESULTS: A two-fold increase in hair acetyl-INH concentrations in the 264 participants in our cohort with hair assays for TB drugs indicated a lower hazard of unfavourable TB treatment outcomes (aHR 0.67, 95%CI 0.44-1.02) and TB treatment failure (aHR 0.65, 95%CI 0.42-1.01). Higher summed concentrations (a summed measure of INH and acetyl-INH) indicated a lower hazard of treatment failure (aHR 0.69, 95%CI 0.45-1.05)CONCLUSION: Hair levels of INH and its metabolite may predict TB treatment outcomes, indicating the potential utility of this measure to assess and optimise TB treatment outcomes.
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Affiliation(s)
- V Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University School of Medicine, Baltimore, MD
| | - D Kadam
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - S Gaikwad
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - A Kinikar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - D Aguilar
- University of California, San Francisco, CA, USA
| | - A Chavan
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - M Paradkar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - S V B Yogendra
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - R Bharadwaj
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - A Kagal
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - N Suryavanshi
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - J Golub
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - V Kulkarni
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - K E Dooley
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - A Gupta
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University School of Medicine, Baltimore, MD
| | - P Bacchetti
- University of California, San Francisco, CA, USA
| | - R Gerona
- University of California, San Francisco, CA, USA
| | - N Gupte
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Gandhi
- University of California, San Francisco, CA, USA
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34
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Manabe YC, Andrade BB, Gupte N, Leong S, Kintali M, Matoga M, Riviere C, Samaneka W, Lama JR, Naidoo K, Zhao Y, Johnson WE, Ellner JJ, Hosseinipour MC, Bisson GP, Salgame P, Gupta A. A Parsimonious Host Inflammatory Biomarker Signature Predicts Incident Tuberculosis and Mortality in Advanced Human Immunodeficiency Virus. Clin Infect Dis 2021; 71:2645-2654. [PMID: 31761933 DOI: 10.1093/cid/ciz1147] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND People with advanced human immunodeficiency virus (HIV) (CD4 < 50) remain at high risk of tuberculosis (TB) or death despite the initiation of antiretroviral therapy (ART). We aimed to identify immunological profiles that were most predictive of incident TB disease and death. METHODS The REMEMBER randomized clinical trial enrolled 850 participants with HIV (CD4 < 50 cells/µL) at ART initiation to receive either empiric TB treatment or isoniazid preventive therapy (IPT). A case-cohort study (n = 257) stratified by country and treatment arm was performed. Cases were defined as incident TB or all-cause death within 48 weeks after ART initiation. Using multiplexed immunoassay panels and ELISA, 26 biomarkers were assessed in plasma. RESULTS In total, 52 (6.1%) of 850 participants developed TB; 47 (5.5%) died (13 of whom had antecedent TB). Biomarkers associated with incident TB overlapped with those associated with death (interleukin [IL]-1β, IL-6). Biomarker levels declined over time in individuals with incident TB while remaining persistently elevated in those who died. Dividing the cohort into development and validation sets, the final model of 6 biomarkers (CXCL10, IL-1β, IL-10, sCD14, tumor necrosis factor [TNF]-α, and TNF-β) achieved a sensitivity of 0.90 (95% confidence interval [CI]: .87-.94) and a specificity of 0.71(95% CI: .68-.75) with an area under the curve (AUC) of 0.81 (95% CI: .78-.83) for incident TB. CONCLUSION Among people with advanced HIV, a parsimonious inflammatory biomarker signature predicted those at highest risk for developing TB despite initiation of ART and TB preventive therapies. The signature may be a promising stratification tool to select patients who may benefit from increased monitoring and novel interventions. CLINICAL TRIALS REGISTRATION NCT01380080.
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Affiliation(s)
- Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bruno B Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), José Silveira Foundation, Salvador, Bahia, Brazil.,Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Nikhil Gupte
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Byramjee-Jeejeebhoy Government Medical College Johns Hopkins University Clinical Research Site, Pune, India
| | - Samantha Leong
- Department of Medicine, Center for Emerging Pathogens, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - Manisha Kintali
- Department of Medicine, Center for Emerging Pathogens, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - Mitch Matoga
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Cynthia Riviere
- Les Centres GHESKIO Clinical Research Site, Port au Prince, Haiti
| | - Wadzanai Samaneka
- University of Zimbabwe College of Health Sciences, Clinical Trials Research Centre, Harare, Zimbabwe
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,CAPRISA-MRC Human Immunodeficiency Virus - Tuberculosis Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Yue Zhao
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - W Evan Johnson
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Jerrold J Ellner
- Department of Medicine, Center for Emerging Pathogens, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - Mina C Hosseinipour
- University of North Carolina Project Malawi, Lilongwe, Malawi.,Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Gregory P Bisson
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Padmini Salgame
- Department of Medicine, Center for Emerging Pathogens, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - Amita Gupta
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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35
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Mave V, Gaikwad S, Barthwal M, Chandanwale A, Lokhande R, Kadam D, Dharmshale S, Bharadwaj R, Kagal A, Pradhan N, Deshmukh S, Atre S, Sahasrabudhe T, Meshram S, Kakrani A, Kulkarni V, Raskar S, Suryavanshi N, Kornfeld H, Dooley KE, Chon S, Gupte A, Gupta A, Gupte N, Golub JE. Diabetes Mellitus and Tuberculosis Treatment Outcomes in Pune, India. Open Forum Infect Dis 2021; 8:ofab097. [PMID: 33884278 PMCID: PMC8047862 DOI: 10.1093/ofid/ofab097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/01/2021] [Indexed: 12/02/2022] Open
Abstract
Background Diabetes mellitus (DM) increases the risk of tuberculosis (TB) disease. Knowledge of the impact of DM on TB treatment outcomes is primarily based on retrospective studies. Methods We conducted a prospective cohort study of new pulmonary TB patients with and without DM (TB-DM and TB only) in India. The association of DM with a composite unfavorable TB treatment outcome (failure, recurrence, mortality) over 18 months was determined, and the effect of DM on all-cause mortality and early mortality (death during TB treatment) was assessed. Results Of 799 participants, 574 (72%) had TB only and 225 (28%) had TB-DM. The proportion of patients with DM who experienced the composite outcome was 20%, as compared with 21% for TB-only participants (adjusted hazard ratio [aHR], 1.13; 95% CI, 0.75–1.70). Mortality was higher in participants with DM (10% vs 7%), and early mortality was substantially higher among patients with DM (aHR, 4.36; 95% CI, 1.62–11.76). Conclusions DM was associated with early mortality in this prospective cohort study, but overall unfavorable outcomes were similar to participants without DM. Interventions to reduce mortality during TB treatment among people with TB-DM are needed.
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Affiliation(s)
- Vidya Mave
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sanjay Gaikwad
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Madhusudan Barthwal
- Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Ajay Chandanwale
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Rahul Lokhande
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Dileep Kadam
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Sujata Dharmshale
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Renu Bharadwaj
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Anju Kagal
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Neeta Pradhan
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Sona Deshmukh
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Sachin Atre
- Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Tushar Sahasrabudhe
- Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Shailesh Meshram
- Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Arjun Kakrani
- Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Vandana Kulkarni
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Swapnil Raskar
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Nishi Suryavanshi
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | | | - Kelly E Dooley
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sandy Chon
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Akshay Gupte
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amita Gupta
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nikhil Gupte
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jonathan E Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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36
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Cox SR, Gupte AN, Thomas B, Gaikwad S, Mave V, Padmapriyadarsini C, Sahasrabudhe TR, Kadam D, Gupte N, Hanna LE, Kagal A, Paradkar M, Thiruvengadam K, Jain D, Atre S, Sekar K, Raskar S, Shivakumar SVBY, Santhappan R, Deshmukh S, Pradhan N, Kulkarni V, Kakrani A, Barthwal MS, Sawant T, DeLuca A, Suryavanshi N, Chander G, Bollinger R, Golub JE, Gupta A. Unhealthy alcohol use independently associated with unfavorable TB treatment outcomes among Indian men. Int J Tuberc Lung Dis 2021; 25:182-190. [PMID: 33688806 DOI: 10.5588/ijtld.20.0778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/10/2022] Open
Abstract
BACKGROUND: Approximately 10% of incident TB cases worldwide are attributable to alcohol. However, evidence associating alcohol with unfavorable TB treatment outcomes is weak.METHODS: We prospectively evaluated men (≥18 years) with pulmonary TB in India for up to 24 months to investigate the association between alcohol use and treatment outcomes. Unhealthy alcohol use was defined as a score of ≥4 on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) scale at entry. Unfavorable TB treatment outcomes included failure, recurrence, and all-cause mortality, analyzed as composite and independent endpoints.RESULTS: Among 751 men, we identified unhealthy alcohol use in 302 (40%). Median age was 39 years (IQR 28-50); 415 (55%) were underweight (defined as a body mass index [BMI] <18.5 kg/m²); and 198 (26%) experienced an unfavorable outcome. Unhealthy alcohol use was an independent risk factor for the composite unfavorable outcome (adjusted incidence rate ratio [aIRR] 1.47, 95% CI 1.05-2.06; P = 0.03) and death (aIRR 1.90, 95% CI 1.08-3.34; P = 0.03), specifically. We found significant interaction between AUDIT-C and BMI; underweight men with unhealthy alcohol use had increased risk of unfavorable outcomes (aIRR 2.22, 95% CI 1.44-3.44; P < 0.001) compared to men with BMI ≥18.5 kg/m² and AUDIT-C <4.CONCLUSION: Unhealthy alcohol use was independently associated with unfavorable TB treatment outcomes, highlighting the need for integrating effective alcohol interventions into TB care.
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Affiliation(s)
- S R Cox
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - A N Gupte
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - B Thomas
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - S Gaikwad
- Byramjee Jeejeebhoy Government Medical College (BJGMC) and Sassoon General Hospital, Pune
| | - V Mave
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune
| | | | - T R Sahasrabudhe
- Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune
| | - D Kadam
- Byramjee Jeejeebhoy Government Medical College (BJGMC) and Sassoon General Hospital, Pune
| | - N Gupte
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune
| | - L E Hanna
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - A Kagal
- Byramjee Jeejeebhoy Government Medical College (BJGMC) and Sassoon General Hospital, Pune
| | - M Paradkar
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - K Thiruvengadam
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - D Jain
- BJGMC Clinical Research Site, Pune
| | - S Atre
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune, Johns Hopkins India Private Limited, Pune, India
| | - K Sekar
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - S Raskar
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - S V B Y Shivakumar
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, Johns Hopkins India Private Limited, Pune, India
| | - R Santhappan
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - S Deshmukh
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - N Pradhan
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - V Kulkarni
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - A Kakrani
- Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune
| | - M S Barthwal
- Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune
| | - T Sawant
- Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune
| | - A DeLuca
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - N Suryavanshi
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - G Chander
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - R Bollinger
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - J E Golub
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - A Gupta
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
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37
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Tornheim JA, Madugundu AK, Paradkar M, Fukutani KF, Queiroz ATL, Gupte N, Gupte AN, Kinikar A, Kulkarni V, Balasubramanian U, Sreenivasamurthy S, Raja R, Pradhan N, Shivakumar SVBY, Valvi C, Hanna LE, Andrade BB, Mave V, Pandey A, Gupta A. Transcriptomic Profiles of Confirmed Pediatric Tuberculosis Patients and Household Contacts Identifies Active Tuberculosis, Infection, and Treatment Response Among Indian Children. J Infect Dis 2021; 221:1647-1658. [PMID: 31796955 DOI: 10.1093/infdis/jiz639] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/03/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Gene expression profiling is emerging as a tool for tuberculosis diagnosis and treatment response monitoring, but limited data specific to Indian children and incident tuberculosis infection (TBI) exist. METHODS Sixteen pediatric Indian tuberculosis cases were age- and sex-matched to 32 tuberculosis-exposed controls (13 developed incident TBI without subsequent active tuberculosis). Longitudinal samples were collected for ribonucleic acid sequencing. Differential expression analysis generated gene lists that identify tuberculosis diagnosis and tuberculosis treatment response. Data were compared with published gene lists. Population-specific risk score thresholds were calculated. RESULTS Seventy-one genes identified tuberculosis diagnosis and 25 treatment response. Within-group expression was partially explained by age, sex, and incident TBI. Transient changes in gene expression were identified after both infection and treatment. Application of 27 published gene lists to our data found variable performance for tuberculosis diagnosis (sensitivity 0.38-1.00, specificity 0.48-0.93) and treatment response (sensitivity 0.70-0.80, specificity 0.40-0.80). Our gene lists found similarly variable performance when applied to published datasets for diagnosis (sensitivity 0.56-0.85, specificity 0.50-0.85) and treatment response (sensitivity 0.49- 0.86, specificity 0.50-0.84). CONCLUSIONS Gene expression profiles among Indian children with confirmed tuberculosis were distinct from adult-derived gene lists, highlighting the importance of including distinct populations in differential gene expression models.
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Affiliation(s)
- Jeffrey A Tornheim
- Center for Clinical Global Health Education, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anil K Madugundu
- Institute of Bioinformatics, Bangalore, Karnataka, India.,Center for Molecular Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.,Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.,Department of Laboratory Medicine and Pathology and Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Kiyoshi F Fukutani
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Faculdade de Tecnologia e Ciências (FTC), Salvador, Brazil
| | - Artur T L Queiroz
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
| | - Nikhil Gupte
- Center for Clinical Global Health Education, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Akshay N Gupte
- Center for Clinical Global Health Education, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aarti Kinikar
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Usha Balasubramanian
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Sreelakshmi Sreenivasamurthy
- Institute of Bioinformatics, Bangalore, Karnataka, India.,Center for Molecular Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.,McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Remya Raja
- Institute of Bioinformatics, Bangalore, Karnataka, India.,Center for Molecular Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.,Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Neeta Pradhan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | | | - Chhaya Valvi
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | | | - Bruno B Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Faculdade de Tecnologia e Ciências (FTC), Salvador, Brazil.,Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Brazil.,Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Vidya Mave
- Center for Clinical Global Health Education, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Akhilesh Pandey
- Institute of Bioinformatics, Bangalore, Karnataka, India.,Center for Molecular Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.,Department of Laboratory Medicine and Pathology and Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA.,McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amita Gupta
- Center for Clinical Global Health Education, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ramachandran G, Chandrasekaran P, Gaikwad S, Agibothu Kupparam HK, Thiruvengadam K, Gupte N, Paradkar M, Dhanasekaran K, Sivaramakrishnan GN, Kagal A, Thomas B, Pradhan N, Kadam D, Hanna LE, Balasubramanian U, Kulkarni V, Murali L, Golub J, Gupte A, Shivakumar SVBY, Swaminathan S, Dooley KE, Gupta A, Mave V. Subtherapeutic Rifampicin Concentration Is Associated With Unfavorable Tuberculosis Treatment Outcomes. Clin Infect Dis 2021; 70:1463-1470. [PMID: 31075166 DOI: 10.1093/cid/ciz380] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The relationships between first-line drug concentrations and clinically important outcomes among patients with tuberculosis (TB) remain poorly understood. METHODS We enrolled a prospective cohort of patients with new pulmonary TB receiving thrice-weekly treatment in India. The maximum plasma concentration of each drug was determined at months 1 and 5 using blood samples drawn 2 hours postdose. Subtherapeutic cutoffs were: rifampicin <8 µg/mL, isoniazid <3 µg/mL, and pyrazinamide <20 µg/mL. Factors associated with lower log-transformed drug concentrations, unfavorable outcomes (composite of treatment failure, all-cause mortality, and recurrence), and individual outcomes were examined using Poisson regression models. RESULTS Among 404 participants, rifampicin, isoniazid, and pyrazinamide concentrations were subtherapeutic in 85%, 29%, and 13%, respectively, at month 1 (with similar results for rifampicin and isoniazid at month 5). Rifampicin concentrations were lower with human immunodeficiency virus coinfection (median, 1.6 vs 4.6 µg/mL; P = .015). Unfavorable outcome was observed in 19%; a 1-μg/mL decrease in rifampicin concentration was independently associated with unfavorable outcome (adjusted incidence rate ratio [aIRR], 1.21 [95% confidence interval {CI}, 1.01-1.47]) and treatment failure (aIRR, 1.16 [95% CI, 1.05-1.28]). A 1-μg/mL decrease in pyrazinamide concentration was associated with recurrence (aIRR, 1.05 [95% CI, 1.01-1.11]). CONCLUSIONS Rifampicin concentrations were subtherapeutic in most Indian patients taking a thrice-weekly TB regimen, and low rifampicin and pyrazinamide concentrations were associated with poor outcomes. Higher or more frequent dosing is needed to improve TB treatment outcomes in India.
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Affiliation(s)
| | | | - Sanjay Gaikwad
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | | | - Nikhil Gupte
- Johns Hopkins School of Medicine, Baltimore, Maryland.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | | | | | - Anju Kagal
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Beena Thomas
- National Institute for Research in Tuberculosis, Chennai
| | - Neeta Pradhan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - Dileep Kadam
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | - Usha Balasubramanian
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | | | - Jonathan Golub
- Johns Hopkins School of Medicine, Baltimore, Maryland.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Akshay Gupte
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | | | - Amita Gupta
- Johns Hopkins School of Medicine, Baltimore, Maryland.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Vidya Mave
- Johns Hopkins School of Medicine, Baltimore, Maryland.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
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39
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Suryavanshi N, Sane M, Gaikwad S, Paradkar M, Mave V, Chandrasekaran P, Shivakumar SVBY, Gupta A, Gupte N, Thomas B. Assessment of persistent depression among TB patients. Int J Tuberc Lung Dis 2020; 24:1208-1211. [PMID: 33172530 DOI: 10.5588/ijtld.20.0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- N Suryavanshi
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
| | - M Sane
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
| | - S Gaikwad
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - M Paradkar
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
| | - V Mave
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - P Chandrasekaran
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
| | - S V B Y Shivakumar
- Johns Hopkins University, Center for Clinical Global Health Education, India Office, Pune, India
| | - A Gupta
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - N Gupte
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - B Thomas
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
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40
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Suryavanshi N, Kadam A, Dhumal G, Nimkar S, Mave V, Gupta A, Cox SR, Gupte N. Mental health and quality of life among healthcare professionals during the COVID-19 pandemic in India. Brain Behav 2020; 10:e01837. [PMID: 32918403 PMCID: PMC7667343 DOI: 10.1002/brb3.1837] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has placed healthcare professionals (HCP) in stressful circumstances with increased patient loads and a high risk of exposure. We sought to assess the mental health and quality of life (QoL) of Indian HCPs, the fourth highest-burden country for COVID-19. METHOD Using snowball sampling, we conducted an online survey in May 2020 among HCPs. Data were collected on demographics, depression, and anxiety using validated tools, quality of life, and perceived stressors. Multivariable logistic regression and principal component analysis were performed to assess risk factors associated with mental health symptoms. FINDINGS Of 197 HCPs assessed, 157 (80%) were from Maharashtra, 130 (66%) from public hospitals, 47 (24%) nurses, 66 (34%) physicians, 101 (52%) females, and 81 (41%) ≤30 years. Eighty-seven percent provided direct COVID-19 care with 43% caring for >10 patients/day. A large proportion reported symptoms of depression (92, 47%), anxiety (98, 50%), and low QoL (89, 45%). Odds of combined depression and anxiety were 2.37 times higher among single HCPs compared to married (95% CI: 1.03-4.96). Work environment stressors were associated with 46% increased risk of combined depression and anxiety (95% CI: 1.15-1.85). Moderate to severe depression and anxiety were independently associated with increased risk of low QoL [OR: 3.19 (95% CI: 1.30-7.84), OR: 2.84 (95% CI: 1.29-6.29)]. CONCLUSION Our study demonstrated a high prevalence of symptoms of depression and anxiety and low QoL among Indian HCPs during the COVID-19 pandemic. There is an urgent need to prevent and treat mental health symptoms among frontline HCPs.
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Affiliation(s)
- Nishi Suryavanshi
- Lakshya, Society for Public Health Education and Research, Pune, India.,Johns Hopkins University, Center for Clinical Global Health Education, Pune, India
| | - Abhay Kadam
- Lakshya, Society for Public Health Education and Research, Pune, India.,Johns Hopkins University, Center for Clinical Global Health Education, Pune, India
| | - Gauri Dhumal
- Lakshya, Society for Public Health Education and Research, Pune, India.,Johns Hopkins University, Center for Clinical Global Health Education, Pune, India
| | - Smita Nimkar
- Lakshya, Society for Public Health Education and Research, Pune, India.,Johns Hopkins University, Center for Clinical Global Health Education, Pune, India
| | - Vidya Mave
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Amita Gupta
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Samyra R Cox
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Nikhil Gupte
- Lakshya, Society for Public Health Education and Research, Pune, India.,Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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41
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Dolla CK, Padmapriyadarsini C, Thiruvengadam K, Lokhande R, Kinikar A, Paradkar M, Bm S, Murali L, Gupte A, Gaikwad S, Selvaraju S, Padmanaban Y, Pattabiraman S, Pradhan N, Kulkarni V, Shivakumar SVBY, Prithivi M, Kagal A, Karthavarayan BT, Suryavanshi N, Gupte N, Kumaran P, Mave V, Gupta A. Age-specific prevalence of TB infection among household contacts of pulmonary TB: Is it time for TB preventive therapy? Trans R Soc Trop Med Hyg 2020; 113:632-640. [PMID: 31225622 DOI: 10.1093/trstmh/trz049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/18/2019] [Accepted: 06/05/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Household contacts (HHCs) of TB patients are at high risk of developing evidence of latent TB infection (LTBI) and active disease from the index patient. We estimated the age-specific prevalence of LTBI and the force of infection (FI), as a measure of recent transmission, among HHCs of active TB patients. METHODS A cross-sectional analysis of HHCs of pulmonary TB patients enrolled in a prospective study, 'CTRIUMPh', was conducted at two sites in India. LTBI was defined as either a positive tuberculin skin test (induration ≥5 mm) or QuantiFERON-Gold in tube test (value ≥0.35 IU/ml) and was stratified by age. FI, which is a measure of recent transmission of infection and calculated using changes in age-specific prevalence rates at specific ages, was calculated. Factors associated with LTBI were determined by logistic regression models. RESULTS Of 1020 HHCs of 441 adult pulmonary TB cases, there were 566 (55%) females and 289 (28%) children aged ≤15 y. While screening for the study 3% of HHC were diagnosed with active TB. LTBI prevalence among HHCs of pulmonary TB was 47% at <6 y, 53% between 6-14 y and 78% between 15-45 y. FI increased significantly with age, from 0.4 to 1.15 in the HHCs cohort (p=0.05). CONCLUSION This study observed an increased prevalence of LTBI and FI among older children and young adults recently exposed to infectious TB in the household. In addition to awareness of coughing etiquette and general hygiene, expanding access to TB preventive therapy to all HHCs, including older children, may be beneficial to achieve TB elimination by 2035.
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Affiliation(s)
- Chandra Kumar Dolla
- Epidemiology, National Institute for Research in Tuberculosis, 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu, India
| | - Chandrasekaran Padmapriyadarsini
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu, India
| | - Kannan Thiruvengadam
- Epidemiology, National Institute for Research in Tuberculosis, 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu, India
| | - Rahul Lokhande
- Pulmonary Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Aarti Kinikar
- Paediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Mandar Paradkar
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research site, Pune, Maharashtra, India
| | - Shrinivas Bm
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu, India
| | | | - Akshay Gupte
- Public Health, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sanjay Gaikwad
- Pulmonary Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Sriram Selvaraju
- Epidemiology, National Institute for Research in Tuberculosis, 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu, India
| | - Yashoda Padmanaban
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu, India
| | - Sathyamurthy Pattabiraman
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu, India
| | - Neeta Pradhan
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research site, Pune, Maharashtra, India
| | - Vandana Kulkarni
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research site, Pune, Maharashtra, India
| | | | - Munivardhan Prithivi
- Epidemiology, National Institute for Research in Tuberculosis, 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu, India
| | - Anju Kagal
- Microbiology, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Barath Thopili Karthavarayan
- Epidemiology, National Institute for Research in Tuberculosis, 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu, India
| | - Nishi Suryavanshi
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research site, Pune, Maharashtra, India.,Public Health, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nikhil Gupte
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research site, Pune, Maharashtra, India.,Public Health, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Paul Kumaran
- Epidemiology, National Institute for Research in Tuberculosis, 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu, India
| | - Vidya Mave
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research site, Pune, Maharashtra, India.,Public Health, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amita Gupta
- Public Health, Johns Hopkins School of Medicine, Baltimore, MD, USA
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42
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Paradkar M, Padmapriyadarsini C, Jain D, Shivakumar SVBY, Thiruvengadam K, Gupte AN, Thomas B, Kinikar A, Sekar K, Bharadwaj R, Dolla CK, Gaikwad S, Elilarasi S, Lokhande R, Reddy D, Murali L, Kulkarni V, Pradhan N, Hanna LE, Pattabiraman S, Kohli R, S. R, Suryavanshi N, B. M. S, Cox SR, Selvaraju S, Gupte N, Mave V, Gupta A, Bollinger RC. Tuberculosis preventive treatment should be considered for all household contacts of pulmonary tuberculosis patients in India. PLoS One 2020; 15:e0236743. [PMID: 32726367 PMCID: PMC7390377 DOI: 10.1371/journal.pone.0236743] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022] Open
Abstract
The World Health Organization (WHO) recently changed its guidance for tuberculosis (TB) preventive treatment (TPT) recommending TPT for all pulmonary TB (PTB) exposed household contacts (HHC) to prevent incident TB disease (iTBD), regardless of TB infection (TBI) status. However, this recommendation was conditional as the strength of evidence was not strong. We assessed risk factors for iTBD in recently-exposed adult and pediatric Indian HHC, to determine which HHC subgroups might benefit most from TPT. We prospectively enrolled consenting HHC of adult PTB patients in Pune and Chennai, India. They underwent clinical, microbiologic and radiologic screening for TB disease (TBD) and TBI, at enrollment, 4–6, 12 and 24 months. TBI testing was performed by tuberculin skin test (TST) and Quantiferon®- Gold-in-Tube (QGIT) assay. HHC without baseline TBD were followed for development of iTBI and iTBD. Using mixed-effect Poisson regression, we assessed baseline characteristics including TBI status, and incident TBI (iTBI) using several TST and/or QGIT cut-offs, as potential risk factors for iTBD. Of 1051 HHC enrolled, 42 (4%) with baseline TBD and 12 (1%) with no baseline TBI test available, were excluded. Of the remaining 997 HHC, 707 (71%) had baseline TBI (TST ≥ 5 mm or QGIT ≥ 0.35 IU/ml). Overall, 20 HHC (2%) developed iTBD (12 cases/1000 person-years, 95%CI: 8–19). HIV infection (aIRR = 29.08, 95% CI: 2.38–355.77, p = 0.01) and undernutrition (aIRR = 6.16, 95% CI: 1.89–20.03, p = 0.003) were independently associated with iTBD. iTBD was not associated with age, diabetes mellitus, smoking, alcohol, and baseline TBI, or iTBI, regardless of TST (≥ 5 mm, ≥ 10 mm, ≥ 6 mm increase) or QGIT (≥ 0.35 IU/ml, ≥ 0.7 IU/ml) cut-offs. Given the high overall risk of iTBD among recently exposed HHCs, and the lack of association between TBI status and iTBD, our findings support the new WHO recommendation to offer TPT to all HHC of PTB patients residing in a high TB burden country such as India, and do not suggest any benefit of TBI testing at baseline or during follow-up to risk stratify recently-exposed HHC for TPT.
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Affiliation(s)
- Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Johns Hopkins University Center for Clinical Global Health Education, Pune, Maharashtra, India
- * E-mail:
| | | | - Divyashri Jain
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | | | | | - Akshay N. Gupte
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Beena Thomas
- National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Aarti Kinikar
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Krithika Sekar
- National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Renu Bharadwaj
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | | | - Sanjay Gaikwad
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - S. Elilarasi
- Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India
| | - Rahul Lokhande
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Devarajulu Reddy
- National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Lakshmi Murali
- National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Johns Hopkins University Center for Clinical Global Health Education, Pune, Maharashtra, India
| | - Neeta Pradhan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Johns Hopkins University Center for Clinical Global Health Education, Pune, Maharashtra, India
| | | | | | - Rewa Kohli
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Johns Hopkins University Center for Clinical Global Health Education, Pune, Maharashtra, India
| | - Rani S.
- National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Nishi Suryavanshi
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Johns Hopkins University Center for Clinical Global Health Education, Pune, Maharashtra, India
| | - Shrinivasa B. M.
- National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Samyra R. Cox
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sriram Selvaraju
- National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Johns Hopkins University Center for Clinical Global Health Education, Pune, Maharashtra, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Johns Hopkins University Center for Clinical Global Health Education, Pune, Maharashtra, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Robert C. Bollinger
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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43
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Suryavanshi N, Kadam A, Gupte N, Hegde A, Kanade S, Sivalenka S, Kumar VS, Gupta A, Bollinger RC, Shankar A, McKenzie‐White J, Mave V. A mobile health-facilitated behavioural intervention for community health workers improves exclusive breastfeeding and early infant HIV diagnosis in India: a cluster randomized trial. J Int AIDS Soc 2020; 23:e25555. [PMID: 32618115 PMCID: PMC7332965 DOI: 10.1002/jia2.25555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION India's national AIDS Control Organization implemented World Health Organization's option B+ HIV prevention of mother-to-child transmission (PMTCT) guidelines in 2013. However, scalable strategies to improve uptake of new PMTCT guidelines to reduce new infection rates are needed. This study assessed impact of Mobile Health-Facilitated Behavioral Intervention on the uptake of PMTCT services. METHODS A cluster-randomized trial of a mobile health (mHealth)-supported behavioural training intervention targeting outreach workers (ORWs) was conducted in four districts of Maharashtra, India. Clusters (one Integrated Counselling and Testing Center (ICTC, n = 119), all affiliated ORWs (n = 116) and their assigned HIV-positive pregnant/postpartum clients (n = 1191)) were randomized to standard-of-care (SOC) ORW training vs. the COMmunity home Based INDia (COMBIND) intervention - specialized behavioural training plus a tablet-based mHealth application to support ORW-patient communication and patient engagement in HIV care. Impact on uptake of maternal antiretroviral therapy at delivery, exclusive breastfeeding at six months, infant nevirapine prophylaxis, and early infant diagnosis at six months was assessed using multi-level random-effects logistic regression models. RESULTS Of 1191 HIV-positive pregnant/postpartum women, 884 were eligible for primary outcome assessment; 487 were randomized to COMBIND. Multivariable analyses identified no statistically significant differences in any primary outcome by study arm. COMBIND was associated with higher uptake of exclusive breastfeeding at two months (adjusted Odds Ratio (aOR), 2.10; 95% CI 1.06 to 4.15) and early infant diagnosis at six weeks (aOR, 2.19; 95% CI 1.05 to 3.98) than SOC. CONCLUSIONS The COMBIND intervention was easily integrated into India's existing PMTCT programme and improved early uptake of two PMTCT components that require self-motivated health-seeking behaviour, thus providing preliminary evidence to support COMBIND as a potentially scalable PMTCT strategy. Further study would identify modifications needed to optimize other PMTCT outcomes.
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Affiliation(s)
| | - Abhay Kadam
- Lakshya, Society for Public Health Education and ResearchPuneIndia
| | - Nikhil Gupte
- School of MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | - Asha Hegde
- National AIDS Control OrganizationNew DelhiIndia
| | - Savita Kanade
- Lakshya, Society for Public Health Education and ResearchPuneIndia
| | - Srilatha Sivalenka
- Division of Global HIV & TB – India Country OfficeUS Centers for Disease Control and PreventionNew DelhiIndia
| | - V Sampath Kumar
- Division of Global HIV & TB – India Country OfficeUS Centers for Disease Control and PreventionNew DelhiIndia
| | - Amita Gupta
- School of MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | | | - Anita Shankar
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | | | - Vidya Mave
- School of MedicineJohns Hopkins UniversityBaltimoreMDUSA
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Suryavanshi N, Kadam A, Kanade S, Gupte N, Gupta A, Bollinger R, Mave V, Shankar A. Acceptability and feasibility of a behavioral and mobile health intervention (COMBIND) shown to increase uptake of prevention of mother to child transmission (PMTCT) care in India. BMC Public Health 2020; 20:752. [PMID: 32448299 PMCID: PMC7245843 DOI: 10.1186/s12889-020-08706-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 04/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A cluster-randomized trial recently demonstrated that an integrated behavioral and mobile technology intervention improved uptake of key components of a Prevention of Mother to Child Transmission (PMTCT) Option B+ program, among HIV- infected pregnant/breastfeeding women in India. To guide scale-up and optimize programmatic implementation, we conducted a mixed-methods evaluation of the feasibility and acceptability of this intervention. METHODS The COMmunity Home Based INDia (COMBIND) study, was conducted in four districts of Maharashtra, India and randomized 119 integrated counseling and testing centers (ICTC) and their outreach workers (ORWs) to the COMBIND intervention, an integrated mHealth application that allowed digital data capture, PMTCT educational videos, SMS alerts for missed visits and reminder for visits, combined with personal empowerment and motivational interviewing training for ORWs. This qualitative evaluation was done through 15 in-depth interviews (IDIs) with ORWs and 15 IDIs with HIV-infected pregnant/breastfeeding women from the intervention arm. Utilizing a concurrent nested mixed-method evaluation approach, we assess the feasibility and acceptability of the study intervention. RESULTS All 30 participants reported that the PMTCT videos were essential in providing easy to understand information on critical aspects of HIV and necessary care related to PMTCT practices. A majority of the ORWs reported that the personal empowerment training with motivational interviewing skills training increased their confidence, motivation and gave them the tools for effectively supporting their clients. The mHealth application improved their working style as it facilitated targeted PMTCT information support, systemized data capture, streamlined their health education delivery practice and provided a sense of work satisfaction. The SMS appointment alerts improved retention in HIV care for mother and baby to the smaller proportion that had access to their phones. Despite reported improvements in knowledge and communication, few ORWs reported that structural challenges such as limited drug stocks, lack of HIV kits or unavailability of trained staff at ICTC, may hamper the uptake of PMTCT services, thus resulting in limited significant impacts of COMBIND on PMTCT outcomes. CONCLUSION This study found that COMBIND intervention is scalable, feasible, beneficial and very well accepted by ORWs and patients, however structural challenges in goods and services remain.
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Affiliation(s)
- Nishi Suryavanshi
- Lakshya Society for Public Health Education and Research, 307, Block II, Llyod Chambers, Mangalwar Peth, Pune, Maharashtra, 411001, India.
| | - Abhay Kadam
- Lakshya Society for Public Health Education and Research, 307, Block II, Llyod Chambers, Mangalwar Peth, Pune, Maharashtra, 411001, India
| | - Savita Kanade
- Lakshya Society for Public Health Education and Research, 307, Block II, Llyod Chambers, Mangalwar Peth, Pune, Maharashtra, 411001, India
| | - Nikhil Gupte
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Amita Gupta
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Robert Bollinger
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Vidya Mave
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Anita Shankar
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
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45
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Valvi C, Chandanwale A, Khadse S, Kulkarni R, Kadam D, Kinikar A, Joshi S, Lokhande R, Pardeshi G, Garg P, Gupte N, Jain D, Suryavanshi N, Golub JE, Shankar A, Gupta A, Dhumal G, Deluca A, Bollinger RC. Delays and barriers to early treatment initiation for childhood tuberculosis in India. Int J Tuberc Lung Dis 2020; 23:1090-1099. [PMID: 31627774 DOI: 10.5588/ijtld.18.0439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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
BACKGROUND: India accounts for 27% of global childhood tuberculosis (TB) burden. Understanding barriers to early diagnosis and treatment in children may improve care and outcomes.METHODS: A cross-sectional study was performed among 89 children initiated on anti-TB treatment from a public hospital in Pune during 2016, using a structured questionnaire and hospital records. Health care providers (HCPs) were defined as medical personnel consulted about the child's TB symptoms. Time-to-treatment initiation (TTI) was defined as the number of days between onset of TB symptoms and anti-TB treatment initiation. Based on Revised National TB Control Programme recommendations, delayed TTI was defined as >28 days.RESULTS: Sixty-seven (75%) of 89 enrolled children had significant TTI delays (median 51 days, interquartile range [IQR] 27-86). Sixty-six (74%) children visited 1-8 HCPs in the private sector before approaching the public sector. The median HCP delay was 28 days (IQR 10-75). Bacille Calmette-Guérin vaccination (aOR 10.96, P = 0.04) and loss of appetite (aOR 4.44, P = 0.04) were associated with delayed TTI.CONCLUSION: The majority of the children had TTI delays due to delays by HCPs in the private sector. Strengthening HCP competency in TB symptom screening and encouraging early referrals are crucial for rapid scaling up of early treatment initiation in childhood TB.
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Affiliation(s)
- C Valvi
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - A Chandanwale
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - S Khadse
- Rajiv Gandhi Medical College and Chatrapati Shivaji Maharaj Hospital, Kalwa, Thane
| | - R Kulkarni
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - D Kadam
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - A Kinikar
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - S Joshi
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - R Lokhande
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - G Pardeshi
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi
| | - P Garg
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - N Gupte
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - D Jain
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - N Suryavanshi
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - J E Golub
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - A Shankar
- Department of Environmental Health and Engineering
| | - A Gupta
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India, Johns Hopkins University School of Medicine, Baltimore, MD
| | - G Dhumal
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - A Deluca
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - R C Bollinger
- Johns Hopkins University School of Medicine, Baltimore, MD
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46
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Elf JL, Variava E, Chon S, Lebina L, Motlhaoleng K, Gupte N, Niaura R, Abrams D, Martinson N, Golub JE. Prevalence and Correlates of Snuff Use, and its Association With Tuberculosis, Among Women Living With HIV in South Africa. Nicotine Tob Res 2020; 21:1087-1092. [PMID: 29986070 DOI: 10.1093/ntr/nty137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/03/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION A higher proportion of people living with HIV (PLWH) smoke compared to the general population, but little information exists about the prevalence and correlates of smokeless tobacco use among PLWH. In South Africa, dry powdered tobacco is inhaled nasally as snuff. METHODS A cross-sectional survey among PLWH attending three HIV clinics was conducted. Snuff use was assessed via self-report and urine cotinine. RESULTS Given the low (3%) prevalence of snuff use among men, analysis was restricted to n = 606 nonsmoking women living with HIV. Half (n = 298, 49%) were snuff users, the majority of whom (n = 244, 84%) had a positive urine cotinine test. In adjusted analysis, snuff use was negatively associated with higher education (relative risk [RR] 0.55; 95% confidence interval [CI]: 0.39, 0.77) and mobile phone ownership (RR 0.83; 95% CI: 0.71, 0.98), and positively associated with ever having tuberculosis (TB) (RR 1.22; 95% CI: 1.03, 1.45). In adjusted analysis, with current TB as the outcome, snuff use was marginally statistically significantly associated with a twofold increase in odds of a current TB diagnosis (odds ratio [OR] 1.99; 95% CI: 0.98, 4.15). DISCUSSION A high proportion of nonsmoking South African women living with HIV use snuff, which was a risk factor for TB. Additional research is needed to understand the relationship between snuff, TB, and other potential health risks. IMPLICATIONS PLWH have a higher prevalence of smoking than their seronegative peers, but there is a paucity of research on smokeless tobacco use in this population, especially in low-resource settings. TB is the leading cause of death among PLWH, and with improvements to HIV treatment and care, PLWH are at greater risk of tobacco-related diseases. We report an extremely high prevalence of snuff use among women living with HIV in South Africa. Further, in this population snuff use is positively associated with ever having a TB diagnosis, as well as currently having TB.
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Affiliation(s)
- Jessica L Elf
- Center for TB Research, Johns Hopkins School of Medicine, Baltimore, MD.,The Schroeder Institute for Tobacco Research and Polity Studies at Truth Initiative, Washington, DC
| | - Ebrahim Variava
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Soweto, South Africa.,Department of Internal Medicine and Department of Health, Klerksdorp Tshepong Hospital Complex, Matlosana, South Africa
| | - Sandy Chon
- Center for TB Research, Johns Hopkins School of Medicine, Baltimore, MD
| | - Limakatso Lebina
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Soweto, South Africa
| | - Katlego Motlhaoleng
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Soweto, South Africa.,Department of Internal Medicine and Department of Health, Klerksdorp Tshepong Hospital Complex, Matlosana, South Africa
| | - Nikhil Gupte
- Center for TB Research, Johns Hopkins School of Medicine, Baltimore, MD
| | - Raymond Niaura
- The Schroeder Institute for Tobacco Research and Polity Studies at Truth Initiative, Washington, DC.,Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Balitimore, MD
| | - David Abrams
- The Schroeder Institute for Tobacco Research and Polity Studies at Truth Initiative, Washington, DC.,Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Balitimore, MD
| | - Neil Martinson
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Soweto, South Africa
| | - Jonathan E Golub
- Center for TB Research, Johns Hopkins School of Medicine, Baltimore, MD
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Gupte AN, Selvaraju S, Paradkar M, Danasekaran K, Shivakumar SVBY, Thiruvengadam K, Dolla C, Shivaramakrishnan G, Pradhan N, Kohli R, John S, Raskar S, Jain D, Momin A, Subramanian B, Gaikwad A, Lokhande R, Suryavanshi N, Gupte N, Salvi S, Murali L, Checkley W, Golub JE, Bollinger R, Chandrasekaran P, Mave V, Gupta A. Respiratory health status is associated with treatment outcomes in pulmonary tuberculosis. Int J Tuberc Lung Dis 2020; 23:450-457. [PMID: 31064624 DOI: 10.5588/ijtld.18.0551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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
<sec id="st1"> <title>BACKGROUND</title> The association between respiratory impairment and tuberculosis (TB) treatment outcomes is not clear. </sec> <sec id="st2"> <title>METHODS</title> We prospectively evaluated respiratory health status, measured using the Saint George's Respiratory Questionnaire (SGRQ), in a cohort of new adult pulmonary TB cases during and up to 18 months following treatment in India. Associations between total SGRQ scores and poor treatment outcomes of failure, recurrence and all-cause death were measured using multivariable Poisson regression. </sec> <sec id="st3"> <title>RESULTS</title> We enrolled 455 participants contributing 619 person-years at risk; 39 failed treatment, 23 had recurrence and 16 died. The median age was 38 years (interquartile range 26-49); 147 (32%) ever smoked. SGRQ scores at treatment initiation were predictive of death during treatment (14% higher risk per 4-point increase in baseline SGRQ scores, 95%CI 2-28, P = 0.01). Improvement in SGRQ scores during treatment was associated with a lower risk of failure (1% lower risk for every per cent improvement during treatment, 95%CI 1-2, P = 0.05). Clinically relevant worsening in SGRQ scores following successful treatment was associated with a higher risk of recurrence (15% higher risk per 4-point increase scores, 95%CI 4-27, P = 0.004). </sec> <sec id="st4"> <title>CONCLUSION</title> Impaired respiratory health status was associated with poor TB treatment outcomes. The SGRQ may be used to monitor treatment response and predict the risk of death in pulmonary TB. </sec>.
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Affiliation(s)
- A N Gupte
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Selvaraju
- National Institute for Research in Tuberculosis, Chennai
| | - M Paradkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - K Danasekaran
- National Institute for Research in Tuberculosis, Chennai
| | | | | | - C Dolla
- National Institute for Research in Tuberculosis, Chennai
| | | | - N Pradhan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - R Kohli
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - S John
- National Institute for Research in Tuberculosis, Chennai
| | - S Raskar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - D Jain
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - A Momin
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - B Subramanian
- National Institute for Research in Tuberculosis, Chennai
| | - A Gaikwad
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - R Lokhande
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune
| | - N Suryavanshi
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - N Gupte
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Salvi
- Chest Research Foundation, Pune, India
| | - L Murali
- National Institute for Research in Tuberculosis, Chennai
| | - W Checkley
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - J E Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Bollinger
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - V Mave
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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48
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Suryavanshi N, Murrill M, Gupta A, Hughes M, Hesseling A, Kim S, Naini L, Jones L, Smith B, Gupte N, Dawson R, Mave V, Meshram S, Mendoza-Ticona A, Sanchez J, Kumarasamy N, Comins K, Conradie F, Shenje J, Nerette Fontain S, Garcia-Prats A, Asmelash A, Nedsuwan S, Mohapi L, Lalloo U, Cristina Garcia Ferreira A, Okeyo E, Swindells S, Churchyard G, Shah NS. Willingness to Take Multidrug-resistant Tuberculosis (MDR-TB) Preventive Therapy Among Adult and Adolescent Household Contacts of MDR-TB Index Cases: An International Multisite Cross-sectional Study. Clin Infect Dis 2020; 70:436-445. [PMID: 30919881 PMCID: PMC7188234 DOI: 10.1093/cid/ciz254] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/26/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Household contacts (HHCs) of individuals with multidrug-resistant tuberculosis (MDR-TB) are at high risk of infection and subsequent disease. There is limited evidence on the willingness of MDR-TB HHCs to take MDR-TB preventive therapy (MDR TPT) to decrease their risk of TB disease. METHODS In this cross-sectional study of HHCs of MDR-TB and rifampicin-resistant tuberculosis (RR-TB) index cases from 16 clinical research sites in 8 countries, enrollees were interviewed to assess willingness to take a hypothetical, newly developed MDR TPT if offered. To identify factors associated with willingness to take MDR TPT, a marginal logistic model was fitted using generalized estimating equations to account for household-level clustering. RESULTS From 278 MDR-TB/RR-TB index case households, 743 HHCs were enrolled; the median age of HHCs was 33 (interquartile range, 22-49) years, and 62% were women. HHC willingness to take hypothetical MDR TPT was high (79%) and remained high even with the potential for mild side effects (70%). Increased willingness was significantly associated with current employment or schooling (adjusted odds ratio [aOR], 1.83 [95% confidence interval {CI}, 1.07-3.13]), appropriate TB-related knowledge (aOR, 2.22 [95% CI, 1.23-3.99]), confidence in taking MDR TPT (aOR, 7.16 [95% CI, 3.33-15.42]), and being comfortable telling others about taking MDR TPT (aOR, 2.29 [95% CI, 1.29-4.06]). CONCLUSIONS The high percentage of HHCs of MDR-TB/RR-TB index cases willing to take hypothetical MDR TPT provides important evidence for the potential uptake of effective MDR TPT when implemented. Identified HHC-level variables associated with willingness may inform education and counseling efforts to increase HHC confidence in and uptake of MDR TPT.
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Affiliation(s)
- Nishi Suryavanshi
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
| | | | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
- Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael Hughes
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Anneke Hesseling
- Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa
| | - Soyeon Kim
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Linda Naini
- Social and Scientific Systems, Inc, Silver Springs, Maryland
| | - Lynne Jones
- Frontier Science and Technology Research Foundation, Amherst, New York
| | - Betsy Smith
- National Institutes of Health, Bethesda, Maryland
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
- Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Rodney Dawson
- University of Cape Town Lung Institute, Mowbray, South Africa
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
- Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Sushant Meshram
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
| | | | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, San Miguel Clinical Research Site, Lima, Peru
| | | | - Kyla Comins
- TASK Applied Science Clinical Research Site, Bellville
| | | | - Justin Shenje
- South African Tuberculosis Vaccine Initiative, Cape Town, South Africa
| | - Sandy Nerette Fontain
- GHESKIO Centers–Institute of Infectious Diseases and Reproductive Health, Port-au-Prince, Haiti
| | | | | | - Supalert Nedsuwan
- Program for HIV Prevention and Treatment-Chiangrai Prachanukroh Hospital, Thailand
| | - Lerato Mohapi
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg
| | - Umesh Lalloo
- Durban International Clinical Research Site, South Africa
| | | | | | | | - Gavin Churchyard
- Aurum Institute
- School of Public Health, University of the Witwatersrand, Johannesburg
- Advancing Care and Treatment for TB/HIV, South African Medical Research Council, Parktown, South Africa
| | - N Sarita Shah
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Deshmukh S, Atre S, Chavan A, Raskar S, Sawant T, Mave V, Gupte N, Gaikwad S, Sahasrabudhe T, Barthwal M, Kakrani A, Kagal A, Gupta A, Bharadwaj R, Pradhan N, Dharmshale S, Golub J. Assessment of the Xpert assay among adult pulmonary tuberculosis suspects with and without diabetes mellitus. Int J Tuberc Lung Dis 2020; 24:113-117. [DOI: 10.5588/ijtld.19.0239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
SETTING: Pune and Pimpri-Chinchwad Municipal Corporation area, Maharashtra State, India.OBJECTIVE: To assess the sensitivity and specificity of the Xpert® MTB/RIF assay among adults with suspected pulmonary tuberculosis (PTB) and with or without diabetes
(DM).DESIGN: As part of a prospective cohort study, we screened 2359 adults presumed to have PTB with no history of TB. All individuals underwent testing for two sputum smears, culture, Xpert, glycated haemoglobin and fasting blood sugar. We calculated sensitivity and specificity
of Xpert by comparing it with TB sputum culture result as a gold standard.RESULTS: Among screened individuals, 483 (20%) were diagnosed with DM and 1153 (49%) with pre-DM; 723 (31%) had no DM. Overall sensitivity of Xpert was 96% (95%CI 95–97) and specificity was 91% (95%CI
89–93). Xpert sensitivity was significantly higher among DM group (98%) than in the ‘No DM' (95%; P < 0.01) and pre-DM (96%; P < 0.05) groups. Among sputum smear-negative individuals, Xpert sensitivity was higher in the DM group than in the No DM (92% vs. 82%;
P = 0.054) and pre-DM group (92% vs. 82%; P = 0.037).CONCLUSION: High sensitivity and specificity of Xpert underscores the need for its rapid scale up for the early detection of TB in settings with a high dual burden of TB and DM.
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Affiliation(s)
- S. Deshmukh
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India, Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, USA
| | - S. Atre
- Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, USA, Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - A. Chavan
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India
| | - S. Raskar
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India
| | - T. Sawant
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - V. Mave
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - N. Gupte
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - S. Gaikwad
- Byramjee-Jeejeebhoy Government Medical College, Pune India
| | - T. Sahasrabudhe
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - M. Barthwal
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - A. Kakrani
- Dr D Y Patil Medical College Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, India
| | - A. Kagal
- Byramjee-Jeejeebhoy Government Medical College, Pune India
| | - A. Gupta
- Johns Hopkins University, Centre for Clinical Global Health Education, Baltimore, MD, USA, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - R. Bharadwaj
- Byramjee-Jeejeebhoy Government Medical College, Pune India
| | - N. Pradhan
- Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India
| | - S. Dharmshale
- Byramjee-Jeejeebhoy Government Medical College, Pune India
| | - J. Golub
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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Shende S, Kale M, Gupte N. Modeling maternal infant HIV transmission having variable hazard rates with two lag time distributions. COMMUN STAT-SIMUL C 2019. [DOI: 10.1080/03610918.2019.1702691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Subhash Shende
- Department of Statistics, Fergusson College, Pune, India
| | - Mohan Kale
- Department of Statistics, Savitribai Phule Pune University, Pune, India
| | - Nikhil Gupte
- Division of Infectious diseases, School of Medicine, Johns Hopkins University, Baltimore, USA
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