HIV-associated pediatric tuberculosis: prevention, diagnosis and treatment
Purpose of review
The detrimental synergy of colliding HIV and tuberculosis (TB) epidemics is most devastating among children and adolescents living with HIV (CALWH) who shoulder a disproportionate burden of all child TB mortality.
Recent findings
CALWH benefit less from Bacille–Calmette Guerin vaccination than HIV-uninfected children and are not receiving TB preventive therapy despite global recommendations. Further, the predictive utility of most diagnostic tools is reduced in CALWH. Finally, antiretroviral and anti-TB drug interactions continue to complicate cotreatment for children. Despite these challenges, rec...
Source: Current Opinion in HIV and AIDS - October 9, 2018 Category: Infectious Diseases Tags: TUBERCULOSIS AND HIV: Edited by Richard E. Chaisson and Haileyesus Getahun Source Type: research
Coordinating the prevention, treatment, and care continuum for HIV-associated tuberculosis in prisons: a health systems strengthening approach
Purpose of review
To advance a re-conceptualized prevention, treatment, and care continuum (PTCC) for HIV-associated tuberculosis (TB) in prisons, and to make recommendations for strengthening prison health systems and reducing HIV-associated TB morbidity and mortality throughout the cycle of pretrial detention, incarceration, and release.
Recent findings
Despite evidence of increased HIV-associated TB burden in prisons compared to the general population, prisoners face entrenched barriers to accessing anti-TB therapy, antiretroviral therapy, and evidence-based HIV and TB prevention. New approaches, suitable for the c...
Source: Current Opinion in HIV and AIDS - October 9, 2018 Category: Infectious Diseases Tags: TUBERCULOSIS AND HIV: Edited by Richard E. Chaisson and Haileyesus Getahun Source Type: research
Challenges of TB and HIV co-treatment: updates and insights
Purpose of review
In the past few years, tuberculosis (TB) has overtaken HIV as the infectious disease with the highest global mortality. Successful management of this syndemic will require improved diagnostic tests, shorter preventive therapies, and more effective treatments, particularly in light of drug-resistant TB.
Recent findings
Results from several major studies have been published or presented recently, including the development of a more sensitive rapid, molecular assay for TB; several new symptom-based screening tools; use of a 1-month regimen for TB prevention; the results of early vs. delayed TB preventiv...
Source: Current Opinion in HIV and AIDS - October 9, 2018 Category: Infectious Diseases Tags: TUBERCULOSIS AND HIV: Edited by Richard E. Chaisson and Haileyesus Getahun Source Type: research
Treatment of drug-resistant tuberculosis among people living with HIV
Purpose of review
This review aims to describe the key principles in treatment of drug-resistant tuberculosis (TB) in people living with HIV, including early access to timely diagnostics, linkage into care, TB treatment strategies including the use of new and repurposed drugs, co-management of HIV disease, and treatment complications and programmatic support to optimize treatment outcomes. These are necessary strategies to decrease the likelihood of poor treatment outcomes including lower treatment completion rates and higher mortality.
Recent findings
Diagnosis of drug-resistant TB is the gateway into care; yet under...
Source: Current Opinion in HIV and AIDS - October 9, 2018 Category: Infectious Diseases Tags: TUBERCULOSIS AND HIV: Edited by Richard E. Chaisson and Haileyesus Getahun Source Type: research
Treatment of drug-susceptible tuberculosis among people living with human immunodeficiency virus infection: an update
Purpose of review
The present review describes recent advances in the treatment of drug-susceptible tuberculosis (DS-TB) among people living with human immunodeficiency virus (PLWH).
Recent findings
Higher than standard rifampicin doses (>10 mg/kg/day) are well tolerated and have improved sterilizing activity. Standard pyrazinamide doses may result in low drug exposures; modeling reveals that higher doses (>25 mg/kg/day) may be required to reach target levels, although safety is unknown. Four-month fluoroquinolone-containing regimens are not recommended in the 2017 World Health Organization DS-TB treatment guideli...
Source: Current Opinion in HIV and AIDS - October 9, 2018 Category: Infectious Diseases Tags: TUBERCULOSIS AND HIV: Edited by Richard E. Chaisson and Haileyesus Getahun Source Type: research
Diagnosis of HIV-associated tuberculosis
Purpose of review
The current review highlights recent advances in tuberculosis (TB) diagnostics that are relevant for clinicians engaged in the care of HIV-positive adults.
Recent findings
The first section focuses on newly available tools, highlighting recent progress. The second section focuses on new diagnostic approaches that are not yet widely available or implemented, but have considerable potential to improve the management of TB/HIV coinfected persons. The final section speculates about future directions that may be fruitful.
Summary
Advances in Mycobacterium tuberculosis nucleic acid amplification-based g...
Source: Current Opinion in HIV and AIDS - October 9, 2018 Category: Infectious Diseases Tags: TUBERCULOSIS AND HIV: Edited by Richard E. Chaisson and Haileyesus Getahun Source Type: research
Recent progress in understanding immune activation in the pathogenesis in HIV–tuberculosis co-infection
Purpose of review
Tuberculosis is the leading infectious cause of death worldwide, and HIV-1 the best recognized risk factor for active TB. This review focuses on immune complex formation; the interplay of type I and II interferon signaling; and T-cell activation in HIV–TB pathogenesis.
Recent findings
Circulating immune complexes and complement, and Fcγ signaling in whole blood act as early markers of TB disease in HIV-1-infected persons. HIV-1 is associated with a type I interferon response in whole blood, reducing the specificity of TB biomarkers dependent on type I and II interferon genes. Type I and type II in...
Source: Current Opinion in HIV and AIDS - October 9, 2018 Category: Infectious Diseases Tags: TUBERCULOSIS AND HIV: Edited by Richard E. Chaisson and Haileyesus Getahun Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in HIV and AIDS)
Source: Current Opinion in HIV and AIDS - October 9, 2018 Category: Infectious Diseases Tags: Editorial Introduction Source Type: research
Chimeric antigen receptor T-cell approaches to HIV cure
Purpose of review
Combination antiretroviral therapy (ART) has enabled tremendous progress in suppressing HIV replication in infected patients. However, ART alone cannot eradicate HIV and its latent, persisting reservoirs. Novel approaches are needed to eradicate the virus or achieve functional cure in the absence of ART.
Recent findings
Adoptive T-cell therapies were initially tested in HIV-infected individuals with limited efficiency. Benefiting from new and improved methodologies, an increasing array of CAR T-cell therapies has been successfully developed in the cancer immunotherapy field, demonstrating promising n...
Source: Current Opinion in HIV and AIDS - August 3, 2018 Category: Infectious Diseases Tags: PROGRESS IN ACHIEVING LONG-TERM HIV REMISSION: Edited by Jean-Daniel Lelièvre and Timothy J. Henrich Source Type: research
Progress in achieving long-term HIV remission
Purpose of review
The purpose of the present review is to describe the major barriers to HIV eradication and assess the most promising cure strategies under investigation.
Recent findings
There are significant challenges to achieve HIV eradication. These include the establishment of persistent latently infected cells, systemic chronic immune activation, and immune dysfunction. Since the announcement of the first HIV cure involving the Berlin patient, several attempts to reproduce these results have failed. Thus, it is widely accepted that long-term HIV remission would be a more feasible approach. Optimization of ART, ...
Source: Current Opinion in HIV and AIDS - August 3, 2018 Category: Infectious Diseases Tags: PROGRESS IN ACHIEVING LONG-TERM HIV REMISSION: Edited by Jean-Daniel Lelièvre and Timothy J. Henrich Source Type: research
Modeling HIV persistence and cure studies
Purpose of review
To provide a summary of the contributions of mathematical modeling to understanding of HIV persistence during antiretroviral therapy.
Recent findings
Although HIV persistence during therapy could be caused by continual viral replication or slow-decaying latent infection, most evidence points toward the latter mechanism. The latent reservoir is maintained by a balance of cell death, proliferation, and reactivation, and new methods to estimate the relative contributions of these rates use a wide range of experimental data. This has led to new quantitative predictions about the potential benefit of ther...
Source: Current Opinion in HIV and AIDS - August 3, 2018 Category: Infectious Diseases Tags: PROGRESS IN ACHIEVING LONG-TERM HIV REMISSION: Edited by Jean-Daniel Lelièvre and Timothy J. Henrich Source Type: research
Ethical issues in HIV remission trials
Purpose of review
Several promising experimental pathways exist for long-term control of HIV in the absence of antiretroviral therapy (HIV ‘remission’) and are now being tested in early clinical studies. These studies can be invasive and pose a host of distinctive risks to participants, as well as to nonparticipants, especially to participants’ fetuses, and sexual partners.
Recent findings
Ethical analyses of these studies have mainly focused on the risks to study participants. They recommend, and some investigators implement, procedures to mitigate risks for participants or to offset them with direct, indirect,...
Source: Current Opinion in HIV and AIDS - August 3, 2018 Category: Infectious Diseases Tags: PROGRESS IN ACHIEVING LONG-TERM HIV REMISSION: Edited by Jean-Daniel Lelièvre and Timothy J. Henrich Source Type: research
Lessons learned from HIV antiretroviral treatment interruption trials
Purpose of review
Clinical trials with an antiretroviral therapy (ART) interruption remains indispensable for assessing strategies for ART-free HIV remission. This review highlights the lessons learned from ART interruption studies so far, including the risks to the participants and implications for HIV remission.
Recent findings
Historically, analytic HIV treatment interruption (ATI) studies were commonly designed with a prolonged duration of ART interruption and with viral load set point as the primary outcome. For a variety of reasons, including participant risk, recent treatment interruption trials have frequently...
Source: Current Opinion in HIV and AIDS - August 3, 2018 Category: Infectious Diseases Tags: PROGRESS IN ACHIEVING LONG-TERM HIV REMISSION: Edited by Jean-Daniel Lelièvre and Timothy J. Henrich Source Type: research
Therapeutic vaccination for HIV: hopes and challenges
Purpose of review
This review summarizes the recent landscape of HIV therapeutic vaccine research, emphasizing the results of randomized controlled trials that included analytical treatment interruption (ATI) to assess efficacy.
Recent findings
Therapeutic vaccines for HIV are designed to re-educate the host immune response in HIV-infected individuals to better control viral replication in the absence of antiretroviral therapy. No therapeutic vaccine has yet to induce long-term HIV remission following ATI in a randomized controlled trial. This is likely because the vaccines have not elicited a broad enough immune resp...
Source: Current Opinion in HIV and AIDS - August 3, 2018 Category: Infectious Diseases Tags: PROGRESS IN ACHIEVING LONG-TERM HIV REMISSION: Edited by Jean-Daniel Lelièvre and Timothy J. Henrich Source Type: research
Post-treatment and spontaneous HIV control
Purpose of review
The aim of the current review is to explore the evidence around virological remission in ART-treated and untreated individuals living with HIV. With increasing evidence and interest in post-treatment control within the HIV-cure field, it is now increasingly important to agree on definitions to allow different ‘controller’ phenotypes to be clearly distinguished and mechanisms compared.
Recent findings
This review explores recent data on potential predictors and mechanisms driving spontaneous and post-treatment control. We explore data on the role of the reservoir as a determinant of control and th...
Source: Current Opinion in HIV and AIDS - August 3, 2018 Category: Infectious Diseases Tags: PROGRESS IN ACHIEVING LONG-TERM HIV REMISSION: Edited by Jean-Daniel Lelièvre and Timothy J. Henrich Source Type: research
