The burden and treatment of HIV in tuberculosis patients in Papua Province, Indonesia: a prospective observational study

<p>Abstract</p> <p>Background</p> <p>New diagnoses of tuberculosis (TB) present important opportunities to detect and treat HIV. Rates of HIV and TB in Indonesia's easternmost Papua Province exceed national figures, but data on co-infection rates and outcomes are lacking. We aimed to measure TB-HIV co-infection rates, examine longitudinal trends, compare management with World Health Organisation (WHO) recommendations, and document progress and outcome.</p> <p>Methods</p> <p>Adults with newly-diagnosed smear-positive pulmonary TB managed at the Timika TB clinic, Papua Province, were offered voluntary counselling and testing for HIV in accordance with Indonesian National Guidelines, using a point-of-care antibody test. Positive tests were confirmed with 2 further rapid tests. Study participants were assessed using clinical, bacteriological, functional and radiological measures and followed up for 6 months.</p> <p>Results</p> <p>Of 162 participants, HIV status was determined in 138 (85.2%), of whom 18 (13.0%) were HIV+. Indigenous Papuans were significantly more likely to be HIV+ than Non-Papuans (Odds Ratio [OR] 4.42, 95% confidence interval [CI] 1.38-14.23). HIV prevalence among people with TB was significantly higher than during a 2003-4 survey at the same TB clinic, and substantially higher than the Indonesian national estimate of 3%. Compared with HIV- study participants, those with TB-HIV co-infection had significantly lower exercise tolerance (median difference in 6-minute walk test: 25 m, p = 0.04), haemoglobin (mean difference: 1.3 g/dL, p = 0.002), and likelihood of cavitary disease (OR 0.35, 95% CI 0.12-1.01), and increased occurrence of pleural effusion (OR 3.60, 95% CI 1.70-7.58), higher rates of hospitalisation or death (OR 11.80, 95% CI 1.82-76.43), but no difference in the likelihood of successful 6-month treatment outcome. Adherence to WHO guidelines was limited by the absence of integration of TB and HIV services, specifically, with no on-site ART prescriber available. Only six people had CD4+ T-cell counts recorded, 11 were prescribed co-trimoxazole and 4 received ART before, during or after TB treatment, despite ART being indicated in 14 according to 2006 WHO guidelines.</p> <p>Conclusions</p> <p>TB-HIV co-infection in southern Papua, Indonesia, is a serious emerging problem especially among the Indigenous population, and has risen rapidly in the last 5 years. Major efforts are required to incorporate new WHO recommendations on TB-HIV management into national guidelines, and support their implementation in community settings.</p

Computerized video-capillaroscopy alteration related to diabetes mellitus and its complications

Diabetes mellitus (DM)-associated hyperglycemia contributes to the initiation and progression of chronic microvascular (MIC) and macrovascular (MAC) complications. To carry out early identification of MIC, standardized and inexpensive tests are needed. Computerized nailfold video-capillaroscopy (CNVC) is a noninvasive tool to easily evaluate MIC at the level of the fingers and could be useful to detect the so-called ‘diabetic capillaropathy’. Aim: This was a prospective study using CNVC to examine the prevalence of capillaroscopic patterns in a cohort of type 1 (T1D) and type 2 (T2D) diabetic individuals, and to assess their relationship with the level of glycemic control (HbA1c) and DM-related complications. Results: Nailfold alterations were found to be more prevalent in diabetics, including tortuosity (p < 0.01), avascular zones (p < 0.01), ectasiae (p < 0.01) and capillary with bizarre shape (p < 0.01). At least two of these patterns were found with a higher prevalence in T1D and T2D individuals vs. controls (p < 0.01). Finally, a higher frequency of ‘capillary score’ equal to or higher than 2 points was found to be associated with worse glycemic control, and with the presence of diabetic retinopathy. Conclusions: These results confirm the presence of a ‘diabetic capillaropathy’, and nailfold capillary alterations appear to be related to the level of glycemic control and the existence of MIC, particularly when retinal damage is involved