A Simple Novel Method for Determining Mortality Rates in HIV Treatment Programs Worldwide

In this Perspective, Gregory Bisson discusses a new article by Matthias Egger and colleagues that introduces a simple method for HIV treatment programs to more accurately estimate the proportion of patients dying in the first year after ART initiation

Cryptococcus and Lymphocytic Meningitis in Botswana

We retrospectively reviewed microbiology data from a tertiary care hospital in Botswana and found that Cryptococcus neoformans was cultured from 15% (193/1307) of all cerebrospinal (CSF) fluid specimens submitted for analysis, making it the most common diagnosed cause of meningitis in this population. Moreover, almost 70% of CSF samples with significant lymphocytosis did not yield a pathogen, suggesting that many causes of lymphocytic meningitis are going undiagnosed

Isoniazid resistance and death in patients with tuberculous meningitis: retrospective cohort study

Objective To determine whether initial isoniazid resistance is associated with death during the treatment of tuberculous meningitis

Lost but Not Forgotten—The Economics of Improving Patient Retention in AIDS Treatment Programs

Gregory Bisson and Jeffrey Stringer discuss the implications of a new study showing how loss to follow-up affects the effectiveness of a public sector HIV program in Côte d'Ivoire

Stroke, thromboembolism and bleeding in patients with atrial fibrillation according to the EHRA valvular heart disease classification

International audienc

Matrix Metalloproteinases in Tuberculosis-Immune Reconstitution Inflammatory Syndrome and Impaired Lung Function Among Advanced HIV/TB Co-infected Patients Initiating Antiretroviral Therapy

AbstractBackgroundHIV-infected patients with pulmonary TB (pTB) can have worsening of respiratory symptoms as part of TB-immune reconstitution inflammatory syndrome (TB-IRIS) following antiretroviral therapy (ART) initiation. Thus, reconstitution of immune function on ART could drive incident lung damage in HIV/TB.MethodsWe hypothesized that increases in matrix metalloproteinases (MMPs), which can degrade lung matrix, on ART are associated with TB-IRIS among a cohort of advanced, ART naïve, HIV-infected adults with pTB. Furthermore, we related early changes in immune measures and MMPs on ART to lung function in an exploratory subset of patients post-TB cure. This study was nested within a prospective cohort study. Rank sum and chi-square tests, Spearman's correlation coefficient, and logistic regression were used for analyses.ResultsIncreases in MMP-8 following ART initiation were independently associated with TB-IRIS (p=0.04; adjusted odds ratio 1.5 [95% confidence interval: 1.0–2.1]; n=32). Increases in CD4 counts and MMP-8 on ART were also associated with reduced forced expiratory volume in one-second post-TB treatment completion (r=−0.7, p=0.006 and r=−0.6, p=0.02, respectively; n=14).ConclusionsART-induced MMP increases are associated with TB-IRIS and may affect lung function post-TB cure. End-organ damage due to TB-IRIS and mechanisms whereby immune restoration impairs lung function in pTB deserve further investigation

Wood dynamics in headwater streams of the Colorado Rocky Mountains

Peer reviewedPublisher PD