Tuberculosis-HIV treatment with rifampicin or rifabutin: are the outcomes different?

BACKGROUND Rifamycins are a group of antibiotics mainly used in the treatment of tuberculosis (TB), however they interact with antiretroviral therapy (ART). Rifabutin allows more regimens options for concomitant imunodeficiency virus (HIV) treatment compared to rifampicin. OBJECTIVE Compare the outcomes of TB-HIV co-infected patients who used rifampicin or rifabutin. METHODS We analysed data from a prospective cohort study at National Institute of Infectious Diseases Evandro Chagas, Rio de Janeiro (RJ), Brazil. Patients who were treated for TB and HIV with rifampicin or rifabutin, from February 2011 to September 2016 were included. FINDINGS There were 130 TB-HIV patients, of whom 102 were treated with rifampicin and 28 with rifabutin. All patients in the rifabutin-treated group and 55% of the rifampicin-treated group patients were ART-experienced. Patients treated with rifampicin had similar abandon and cure rates, interruptions in treatment due to adverse reactions, immune reconstitution inflammatory syndrome and a similar mortality rate as those treated with rifabutin. However, rifampicin-treated patients had higher CD4 counts and more frequently undetectable HIV viral load by the end of treatment (67% versus 18%, p < 0.001) compared to rifabutin-treated patients, even when only ART-experienced patients were evaluated (66,6% versus 36,3%, p = 0.039). CONCLUSIONS Patients who used rifabutin had worst immune and virological control. This group had more ART-experienced patients. New and simpler regimens are needed for patients who do not respond to previous antiretroviral therapies

Danger in the streets: exposures to bloodborne pathogens after community sharp injuries in Rio de Janeiro, Brazil

Objective: Exposures to sharps injuries occurring in the community are relatively frequent. We describe characteristics of community sharp exposures reported in the city of Rio de Janeiro from 1997 to 2010. Methods: A cross-sectional analysis of exposure reports to sharps in the community reported to a surveillance system, designed for health care workers, of the Municipal Health Department of Rio de Janeiro. The characteristics of exposed individuals analyzed included types of exposure, the circumstances of the accident, and the prophylaxis offered. Results: 582 exposures were studied. Median age was 30 years and 83 (14%) involved children with less than 10 years of age. Two hundred and seventeen (37%) occurred with sharps found in the streets. The exposure was percutaneous in 515 (89%) and needles where involved in 406 (70%) of them. The sharps were present in the trash in 227 (39%) or in the environment in 167 (29%) of the reports. Professionals who work with frequent contact with domestic or urban waste were 196 (38%). The source was known in 112 (19%) of the exposures and blood was involved in 269 (46%). Only 101 (19%) of the injured subjects reported a complete course of vaccination for hepatitis B. Antiretroviral prophylaxis was prescribed for 392 (68%) of the exposed subjects. Conclusions: Sharps injuries occurring in the community are an important health problem. A great proportion would be avoided if practices on how to dispose needles and sharps used outside health units were implemented. Keywords: Needlestick, Bloodborne, HIV, Hepatitis, Medical waste, Sharp injuries, Postexposure prophylaxi

Preditores dos desfechos do tratamento da tuberculose

OBJETIVO: Analisar os desfechos do tratamento da tuberculose e seus preditores. MÉTODOS: Estudo longitudinal de coorte de pacientes com tuberculose tratados entre 2004 e 2006 no Instituto de Pesquisa Evandro Chagas, na cidade do Rio de Janeiro. As razões de risco ajustadas (RRa) dos preditores foram estimadas. RESULTADOS: Foram incluídos 311 pacientes. As taxas de cura, de abandono, de mortalidade e de falha terapêutica foram, respectivamente, 72%, 19%, 6% e 2%. A troca de regime terapêutico por eventos adversos foi necessária em 8%. O alcoolismo (RRa, 0,30), uso do regime estreptomicina+etambutol+ofloxacina (SEO; RRa, 0,32), infecção por HIV sem tratamento antirretroviral (TARV; RRa, 0,36) e o uso do regime rifampicina+isoniazida+pirazinamida+etambutol (RRa, 0,58) reduziram a probabilidade de cura. A faixa etária mais jovem (RRa, 3,84) e o alcoolismo (RRa, 1,76) aumentaram a probabilidade do abandono. Não foi possível determinar as RRa para os demais desfechos devido a suas baixas prevalências. Entretanto, medidas do risco relativo (RR) identificaram os seguintes potenciais preditores do óbito: uso de esquema SEO (RR, 11,43), infecção pelo HIV sem TARV (RR, 9,64), forma clínica disseminada (RR, 9,09), ausência de confirmação bacteriológica (RR, 4,00), diabetes mellitus (RR, 3,94) e comportamento homo/bissexual (RR, 2,97). A baixa renda (RR, 11,70) foi potencial preditor para falha terapêutica, ao passo que infecção pelo HIV com uso de TARV (RR, 2,46) e forma clínica disseminada (RR, 3,57) foram potenciais preditores para troca do esquema por evento adverso. CONCLUSÕES: O esquema SEO deve ser utilizado transitoriamente quando possível. Os dados confirmam a importância de TARV e sugerem a necessidade de seu início precoce

Factors impacting early mortality in tuberculosis/HIV patients: differences between subjects naïve to and previously started on HAART

Submitted by Repositório Arca ([email protected]) on 2019-04-24T16:50:35Z No. of bitstreams: 1 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-10-25T12:23:24Z (GMT) No. of bitstreams: 2 ve_Schmaltz_Carolina_etal_INI_2012.pdf: 241455 bytes, checksum: f6f1c08157c28f8582d5fa7407197533 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2019-10-25T12:23:24Z (GMT). No. of bitstreams: 2 ve_Schmaltz_Carolina_etal_INI_2012.pdf: 241455 bytes, checksum: f6f1c08157c28f8582d5fa7407197533 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2012Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Hospital Universitário Clementino Fraga Filho. Infectious Diseases Clinic. Rio de Janeiro, RJ, Brazil / Universidade Federal do Rio de Janeiro. Department of Preventive Medicine. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Laboratório de Bacteriologia e Bioensaios. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Laboratório de Bacteriologia e Bioensaios. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Immunology Laboratory. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil / Universidade Federal do Estado do Rio de Janeiro. Department of Mathmatics and Statistics. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Background: Mortality among patients with tuberculosis (TB)/HIV is highest during the first few months of antituberculous therapy. The objective of this study was to assess the factors associated with early mortality among TB/HIV patients and whether these factors are similar for HAART naı¨ve and those with prior HAART initiation. Methods: Prospective cohort study including HIV patients with tuberculosis confirmed by culture, cared for at a referral center in Rio de Janeiro, Brazil. Multivariable Cox analysis was used to assess predictors of mortality within 3 months of antituberculous therapy. Results: Among 227 patients included, 90 (40%) started HAART before TB diagnosis. The median time to TB diagnosis after ARV initiation was 5.9 months (interquartile range [IQR] 3.0–8.9 months). Fourteen patients (6%) died within the first 3 months. Mortality was not different between patients previously started on HAART and those who were naïve to it. In the overall adjusted analysis, HAART use during TB treatment (hazard ratio [HR] = 0.21, 95% confidential interval [CI] = 0.06–0.72) and CD4 lymphocyte count .100 cells/mm3 (HR = 0.21, 95% CI = 0.04–0.99) were associated with lower mortality, while subjects with unknown baseline CD4 lymphocyte count (HR = 9.39, 95% CI = 2.56–34.5) had higher mortality. In subgroup analysis, among HAART naı¨ve subjects, disseminated TB (HR = 5.32, 95% CI = 1.09–25.8) and unknown baseline CD4 lymphocyte count (HR = 13.2, 95% CI = 2.71–64.5) were associated with significantly higher mortality, while HAART (HR = 0.14, 95% CI = 0.03–0.69) predicted a better outcome. Among subjects previously started on HAART, mortality was significantly associated with duration of TB symptoms .120 days (HR = 6.15, 95% CI = 1.15–32.9). Conclusions: Predictors of early mortality among TB/HIV patients may vary according to the timing of HAART initiation. Among HAART naïve patients, mortality was influenced by baseline clinical severity, HAART use and, possibly, the quality of care preceding TB diagnosis. For patients with prior HAART initiation, longer delays in TB diagnosis predicted a significantly higher mortality

Cutaneous tuberculosis and HIV infection at a referral centre in Rio de Janeiro, Brazil

Submitted by Janaína Nascimento ([email protected]) on 2019-01-18T11:27:28Z No. of bitstreams: 1 ve_Mann_Danielle_etal_INI_2018.pdf: 732770 bytes, checksum: d49f7837eb1215a120fa05c9da699184 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-01-18T13:24:32Z (GMT) No. of bitstreams: 1 ve_Mann_Danielle_etal_INI_2018.pdf: 732770 bytes, checksum: d49f7837eb1215a120fa05c9da699184 (MD5)Made available in DSpace on 2019-01-18T13:24:32Z (GMT). No. of bitstreams: 1 ve_Mann_Danielle_etal_INI_2018.pdf: 732770 bytes, checksum: d49f7837eb1215a120fa05c9da699184 (MD5) Previous issue date: 2018Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Dermatologia Infecciosa. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Dermatologia Infecciosa. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Dermatologia Infecciosa. Rio de Janeiro, RJ, Brasil.BACKGROUND: Cutaneous tuberculosis (CTB) is a rare extrapulmonary form of tuberculosis (TB). Despite the increase in the number of cases of TB and HIV, few cases of CTB have been reported. OBJECTIVE To describe CTB cases among patients with HIV infection from a cohort with tuberculosis. METHODS We describe a series of 15 CTB and HIV cases, based on secondary data from 2000 to 2016. Diagnosis was based on isolation of Mycobacterium tuberculosis in culture or clinical response to anti-tuberculous treatment associated with positive smear or histopathologic findings from affected skin or an adjacent lymph node. FINDINGS; Scrofuloderma was present in 12 (80%) patients and solitary gumma in three (20%) patients. One case of scrofuloderma was associated with papulonecrotic tuberculid. Seven (46.6%) patients had pulmonary TB. Diagnosis was based on culture in nine patients (60%). The median CD4 cell count was 262 cells/µL. All patients were cured at the end of treatment (median time 6 months). Three patients presented with immune reconstitution inflammatory syndrome. CONCLUSIONS: In this study, CTB associated with HIV infection presented as localised forms or in association with pulmonary TB. In patients with HIV who have subacute and chronic skin lesions, CTB should be considered in differential diagnosis, which may represent a good opportunity for early diagnosis of active TB

Pharmacological interaction of lopinavir/ritonavir 800/200 mg BID and rifampicin in subjects presenting tuberculosis with contraindication for an efavirenz containing antiretroviral regimen

Submitted by Janaína Nascimento ([email protected]) on 2019-06-05T12:44:51Z No. of bitstreams: 1 ve_Schmaltz_Carolina_etal_INI_2014.pdf: 635867 bytes, checksum: 532cc429ee64ce1457a9edae50f2b77a (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-06-05T12:59:05Z (GMT) No. of bitstreams: 1 ve_Schmaltz_Carolina_etal_INI_2014.pdf: 635867 bytes, checksum: 532cc429ee64ce1457a9edae50f2b77a (MD5)Made available in DSpace on 2019-06-05T12:59:05Z (GMT). No. of bitstreams: 1 ve_Schmaltz_Carolina_etal_INI_2014.pdf: 635867 bytes, checksum: 532cc429ee64ce1457a9edae50f2b77a (MD5) Previous issue date: 2014Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.University of Miami. School of Medicine. Division of Infectious Disease. Miami, FL, USA.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.Rifampicin reduces plasma concentration of most HIV protease inhibitors. Lopinavir boosted with ritonavir (LPV/r) could be an option to treat TB-HIV patients. Our aim was to evaluate lopinavir interaction with rifampicin during TB-HIV therapy. TB-HIV patients who could not use efavirenz and with no genotypic resistance to lopinavir were included. Rifampicin 600 mg, isoniazid 400 mg and pyrazinamide 2000 mg were started at day one for 6 months and LPV/r plus two nucleoside/nucleotide reverse transcriptase inhibitors were introduced at day 30. LPV/r dose was started at 400/100 mg BID and escalated over 7 days to 800/200 mg BID. Pharmacokinetic sampling was performed at day 15 (rifampicin), 45, 90, 180 (rifampicin, lopinavir, ritonavir) and 210 (lopinavir, ritonavir). Viral load (VL) and CD4 counts were performed at baseline and days 30, 60, 120, and 180. Genotypic testing was done in baseline and in the last visit. Fifteen patients were enrolled. Five were excluded during exclusively TB therapy. After LPV/r introduction five patients were excluded, three due to adverse events, and two due to low adherence. Five patients finished the study, two of them with VL<50 copies/mL. LPV/r genotypic resistance was detected in one patient. Lopinavir concentrations were below 1µg/mL in 4/10 patients (in one study point), and one in two study points. Lopinavir concentrations were above 4 µg/mL in 6/10 patients, at least in one pharmacokinetic sample. Although target drug concentrations of lopinavir were achieved for most patients, adverse events were frequent and low adherence was observed for both TB and HIV therapies, showing how difficult it is to treat both diseases simultaneously. Hepatic and pancreatic enzymes should be routinely monitored

Distribution of Variables According to HAART Status at Baseline.

<p>HAART = highly active anti-retroviral therapy; TB = tuberculosis; IRIS = immune reconstitution inflammatory syndrome;</p>a<p>median (interquartile range).</p>b<p>missing data for 37 (16%) patients.</p>c<p>missing data for 50 (22%) patients.</p

Univariate Cox Analysis of Predictors of Early Mortality.

<p>TB = tuberculosis; CI = confidence interval; HAART = highly active anti-retroviral therapy; IRIS = immune reconstitution inflammatory syndrome;</p>a<p>median;</p>b<p>missing data for 37 (16%) patients;</p>c<p>missing data for 32 (14%) patients;</p>d<p>missing data for 50 (22%) patients;</p>e<p>time-dependent variable.</p

Distribution of Baseline and Follow-up Variables.

<p>TB = tuberculosis; HAART = highly active anti-retroviral therapy; IRIS = immune reconstitution inflammatory syndrome;</p>a<p>median (interquartile range);</p>b<p>missing data for 37 (16%) patients;</p>c<p>missing data for 32 (14%) patients;</p>d<p>missing data for 50 (22%) patients.</p