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Matoga MM, Bisson GP, Gupta A, Miyahara S, Sun X, Fry C, Manabe YC, Kumwenda J, Cecilia K, Nyirenda M, Ngongondo M, Mbewe A, Lagat D, Wallis C, Mugerwa H, Hosseinipour MC. Urine Lipoarabinomannan Testing in Adults With Advanced Human Immunodeficiency Virus in a Trial of Empiric Tuberculosis Therapy. Clin Infect Dis 2021; 73:e870-e877. [PMID: 34398958 PMCID: PMC8366821 DOI: 10.1093/cid/ciab179] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The urine lipoarabinomannan (LAM) antigen test is a tuberculosis (TB) diagnostic test with highest sensitivity in individuals with advanced human immunodeficiency virus (HIV). Its role in TB diagnostic algorithms for HIV-positive outpatients remains unclear. METHODS The AIDS Clinical Trials Group (ACTG) A5274 trial demonstrated that empiric TB therapy did not improve 24-week survival compared to isoniazid preventive therapy (IPT) in TB screen-negative HIV-positive adults initiating antiretroviral therapy with CD4 counts <50 cells/µL. Retrospective LAM testing was performed on stored urine obtained at baseline. We determined the proportion of LAM-positive participants and conducted modified intent-to-treat analysis excluding LAM-positive participants to determine the effect on 24-week survival, TB incidence, and time to TB using Kaplan-Meier method. RESULTS A5274 enrolled 850 participants; 53% were male and the median CD4 count was 18 (interquartile range, 9-32) cells/µL. Of the 850, 566 (67%) had LAM testing (283 per arm); 28 (5%) were positive (21 [7%] and 7 [2%] in the empiric and IPT arms, respectively). Of those LAM-positive, 1 participant in each arm died and 5 of 21 and 0 of 7 in empiric and IPT arms, respectively, developed TB. After excluding these 28 cases, there were 19 and 21 deaths in the empiric and IPT arms, respectively (P = .88). TB incidence remained higher (4.6% vs 2%, P = .04) and time to TB remained faster in the empiric arm (P = .04). CONCLUSIONS Among outpatients with advanced HIV who screened negative for TB by clinical symptoms, microscopy, and Xpert testing, LAM testing identified an additional 5% of individuals with TB. Positive LAM results did not change mortality or TB incidence.
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Affiliation(s)
| | - Gregory P Bisson
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amita Gupta
- Center for Clinical Global Health Education, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sachiko Miyahara
- Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Xin Sun
- Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Carrie Fry
- Frontier Science Foundation, Amherst, New York, USA
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Johnstone Kumwenda
- Malawi College of Medicine–Johns Hopkins University Research Project, Blantyre, Malawi
| | | | - Mulinda Nyirenda
- Malawi College of Medicine–Johns Hopkins University Research Project, Blantyre, Malawi
| | | | - Abineli Mbewe
- University of North Carolina Project, Lilongwe, Malawi
| | - David Lagat
- Moi University School of Medicine, Eldoret, Kenya
| | - Carole Wallis
- Bioanalytical Research Corporation and Lancet Laboratories, Johannesburg, South Africa
| | | | - Mina C Hosseinipour
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,USA
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Meeter LHH, Steketee RME, Salkovic D, Vos ME, Grossman M, McMillan CT, Irwin DJ, Boxer AL, Rojas JC, Olney NT, Karydas A, Miller BL, Pijnenburg YAL, Barkhof F, Sánchez-Valle R, Lladó A, Borrego-Ecija S, Diehl-Schmid J, Grimmer T, Goldhardt O, Santillo AF, Hansson O, Vestberg S, Borroni B, Padovani A, Galimberti D, Scarpini E, Rohrer JD, Woollacott IOC, Synofzik M, Wilke C, de Mendonca A, Vandenberghe R, Benussi L, Ghidoni R, Binetti G, Niessen WJ, Papma JM, Seelaar H, Jiskoot LC, de Jong FJ, Donker Kaat L, Del Campo M, Teunissen CE, Bron EE, Van den Berg E, Van Swieten JC. Clinical value of cerebrospinal fluid neurofilament light chain in semantic dementia. J Neurol Neurosurg Psychiatry 2019; 90:997-1004. [PMID: 31123142 PMCID: PMC6820157 DOI: 10.1136/jnnp-2018-319784] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/12/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Semantic dementia (SD) is a neurodegenerative disorder characterised by progressive language problems falling within the clinicopathological spectrum of frontotemporal lobar degeneration (FTLD). The development of disease-modifying agents may be facilitated by the relative clinical and pathological homogeneity of SD, but we need robust monitoring biomarkers to measure their efficacy. In different FTLD subtypes, neurofilament light chain (NfL) is a promising marker, therefore we investigated the utility of cerebrospinal fluid (CSF) NfL in SD. METHODS This large retrospective multicentre study compared cross-sectional CSF NfL levels of 162 patients with SD with 65 controls. CSF NfL levels of patients were correlated with clinical parameters (including survival), neuropsychological test scores and regional grey matter atrophy (including longitudinal data in a subset). RESULTS CSF NfL levels were significantly higher in patients with SD (median: 2326 pg/mL, IQR: 1628-3593) than in controls (577 (446-766), p<0.001). Higher CSF NfL levels were moderately associated with naming impairment as measured by the Boston Naming Test (rs =-0.32, p=0.002) and with smaller grey matter volume of the parahippocampal gyri (rs =-0.31, p=0.004). However, cross-sectional CSF NfL levels were not associated with progression of grey matter atrophy and did not predict survival. CONCLUSION CSF NfL is a promising biomarker in the diagnostic process of SD, although it has limited cross-sectional monitoring or prognostic abilities.
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Affiliation(s)
- Lieke H H Meeter
- Alzheimer Center and Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Rebecca M E Steketee
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Dina Salkovic
- Alzheimer Center and Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Maartje E Vos
- Alzheimer Center and Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Murray Grossman
- Penn FTD Center, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Corey T McMillan
- Penn FTD Center, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David J Irwin
- Penn FTD Center, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adam L Boxer
- Neurology, Memory and Aging Center University of California San Francisco, San Francisco, California, USA
| | - Julio C Rojas
- Neurology, Memory and Aging Center University of California San Francisco, San Francisco, California, USA
| | - Nicholas T Olney
- Neurology, University of California San Francisco Memory and Aging Center, San Francisco, California, USA
| | - Anna Karydas
- Neurology, University of California San Francisco Memory and Aging Center, San Francisco, California, USA
| | - Bruce L Miller
- Neurology, Memory and Aging Center University of California San Francisco, San Francisco, California, USA
| | - Yolande A L Pijnenburg
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Neurology and Healthcare Engineering, University College London Medical School, London, UK
| | - Raquel Sánchez-Valle
- Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Albert Lladó
- Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Sergi Borrego-Ecija
- Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Oliver Goldhardt
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Alexander F Santillo
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Barbara Borroni
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Daniela Galimberti
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca' Granda, Ospedale Policlinico, Milan, Italy
- Biomedical, Surgical and Dental Sciences, University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Elio Scarpini
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca' Granda, Ospedale Policlinico, Milan, Italy
- Pathophysiology and Transplantation, University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Diseases, UCL Institute of Neurology, London, UK
| | - Ione O C Woollacott
- Dementia Research Centre, Department of Neurodegenerative Diseases, UCL Institute of Neurology, London, UK
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Carlo Wilke
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Alexandre de Mendonca
- Institute of Molecular Medicine and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Rik Vandenberghe
- Department of Neurology, University Hospital Leuven, Leuven, Belgium
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Vlaanderen, Belgium
| | - Luisa Benussi
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Roberta Ghidoni
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuliano Binetti
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- MAC Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Wiro J Niessen
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
- Imaging Physics, Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - Janne M Papma
- Alzheimer Center and Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Harro Seelaar
- Alzheimer Center and Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Lize C Jiskoot
- Alzheimer Center and Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Frank Jan de Jong
- Alzheimer Center and Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Laura Donker Kaat
- Alzheimer Center and Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
- Department of Clinical Genetics, Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
| | - Marta Del Campo
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Esther E Bron
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Esther Van den Berg
- Alzheimer Center and Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - John C Van Swieten
- Alzheimer Center and Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
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Udwadia ZF, Tornheim JA, Ganatra S, DeLuca A, Rodrigues CS, Gupta A. Few eligible for the newly recommended short course MDR-TB regimen at a large Mumbai private clinic. BMC Infect Dis 2019; 19:94. [PMID: 30691407 PMCID: PMC6350313 DOI: 10.1186/s12879-019-3726-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 05/17/2018] [Accepted: 01/14/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND India has the world's highest tuberculosis burden, and Mumbai is particularly affected by multidrug resistant tuberculosis (MDR-TB). WHO recommends short, intensive treatment ("Short Course") for previously untreated pulmonary MDR-TB patients but does not require universal drug susceptibility testing (DST) before Short Course. DST would likely screen out many MDR-TB patients in places like Mumbai with significant drug resistance. METHODS MDR-TB patients at a private clinic were recruited for a prospective observational cohort. Short Course eligibility was evaluated by clinical criteria and DST results. Eligibility by DST was classified as rifampin monoresistance (as tested by Xpert MTB/RIF), rifampin, fluoroquinolones, and 2nd-line injectable drugs resistance (as tested by line probe assays) and resistance to other drugs. RESULTS Of 559 participants with MDR-TB, 33% met clinical eligibility for Short Course. DST for rifampin, fluoroquinolones, and 2nd-line injectable drugs excluded 74.7% of participants. Complete phenotypic DST excluded 96.6% of participants. Prior treatment with either 1st or 2nd-line drugs did not significantly affect eligibility. CONCLUSIONS In a global MDR-TB hotspot, < 5% of participants with MDR-TB were appropriate for Short Course by clinical characteristics and DST results. Rapid molecular testing would not sufficiently identify drug resistance in this population. Eligibility rates were not significantly reduced by prior TB treatment.
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Affiliation(s)
- Zarir F. Udwadia
- Medical Research Centre, P.D. Hinduja National Hospital, Veer Savarkar Road, Mahim, Mumbai, Maharashtra 400016 India
| | - Jeffrey A. Tornheim
- Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 521, Baltimore, MD 21287 USA
| | - Shashank Ganatra
- Medical Research Centre, P.D. Hinduja National Hospital, Veer Savarkar Road, Mahim, Mumbai, Maharashtra 400016 India
| | - Andrea DeLuca
- Division of Global Disease Epidemiology and Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287 USA
| | - Camilla S. Rodrigues
- Medical Research Centre, P.D. Hinduja National Hospital, Veer Savarkar Road, Mahim, Mumbai, Maharashtra 400016 India
| | - Amita Gupta
- Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 521, Baltimore, MD 21287 USA
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