TB and HIV: A Deadly Partnership  MOPDB2
Organiser:
Type:
Poster Discussion Back
Venue: SBR 10
Interpretation: None
Time: 13:00 - 14:00, 04.08.2008
Code: MOPDB2
Chairpersons: Jean Pape, Haiti
Juan Sierra Madero, Mexico (Point Person)




Presentations in this session:

13:00
MOPDB201
Powerpoint (272 KB)		Introduction: Interaction between HAART and TB treatment
Jean Pape, Haiti


13:05
MOPDB202
Abstract
Powerpoint (194 KB)		Incidences of latent and active tuberculosis among MTCT-Plus patients who received annual tuberculin skin test with isoniazid preventive therapy in Thailand: a 4-year follow up
Presented by Nittaya Phanuphak, Thailand
N. Phanuphak1, T. Apornpong1, A. Avihingsanon2, N. Teeratakulpisarn1, E. Abrams3, P. Phanuphak1
1The Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 2The HIV Netherlands Australia Thailand Research Collabolation, Bangkok, Thailand, 3Columbia University, New York, United States


13:10
MOPDB203
Abstract		Epidemiological, clinical, biological characteristics and treatment outcomes of a cohort of HIV-TB patients enrolled in the integrated HIV care for tuberculosis patients program (IHC) in Mandalay, Myanmar
Presented by Min Thwe, Myanmar
M. Thwe1, W. Maung2, P. Par3, B. Myint4, M. Zaw5, N. Wilson6, S. Hsai Mine7, H. Klughe8, T. Aye9, O. Picard10, P. Clevenbergh11
1National AIDS Program, Ministry of Health, Nay Pyi Taw, Myanmar, 2National Tuberculosis Program, Ministry of Health, Nay Pyi Taw, Myanmar, 3Mandalay General Hospital, Medical Unit 1, Mandalay, Myanmar, 4National Tuberculosis Program, Mandalay, Myanmar, 5National Tuberculosis Program, Nay Pyi Taw, Myanmar, 6International Union Against Tuberculosis and Lung Disease, New Delhi, India, 7International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar, 8World Health Organization, Tuberculosis, Yangon, Myanmar, 9World Health Organization, Tuberculosis, Mandalay, Myanmar, 10Hopital St Antoine, Internal Medicine, Paris, France, 11International Union Against Tuberculosis and Lung Disease, HIV, Mandalay, Myanmar


13:15
MOPDB204
Abstract
Powerpoint (66 KB)		Response to HAART in naïve patients with a diagnosis of tuberculosis
Presented by Santiago Moreno, Spain
S. Moreno1, P. Sobrino2, A.M. Caro Murillo2, J.A. Iribarren3, J.M. Ramos4, F. Vidal5, G. Navarro6, J. López Aldeguer7, I. Santos8, J. del Amo2, CoRIS
1Hospital Ramón y Cajal, Infectious Diseases, Madrid, Spain, 2Centro Nacional de Epidemiología, CoRIS, Madrid, Spain, 3Hospital Donostia, Infectious Diseases, San Sebastián, Spain, 4Hospital de Elche, Infectious Diseases, Elche, Spain, 5Hospital Joan XXIII, Infectious Diseases, Tarragona, Spain, 6Hospital Parc Tauli, Infectious Diseases, Sabadell, Spain, 7Hospital La Fe, Infectious Diseases, Valencia, Spain, 8Hospital de la Princesa, Infectious Diseases, Madrid, Spain


13:20
MOPDB205
Abstract
Powerpoint (638 KB)		Early initiation of antiretroviral therapy results in decreased morbidity and mortality among patients with advanced HIV disease
Presented by Payam Tabarsi, Iran, Islamic Republic of
P. Tabarsi1, A. Tehrani1, P. Baghaei1, D. Mansouri1, M. Masjedi1, F. Altice2
1Mycobacteriology Research Center, Tehran, Iran, Islamic Republic of, 2Yale University AIDS Program, New Haven, United States


13:25
MOPDB206
Abstract
Powerpoint (430 KB)		Early versus late cART treatment in HIV/TB co-infected patients in Argentina
Presented by Javier Jose Toibaro, Argentina
J.J. Toibaro1, E. Warley2, J.M. Bruguera1, N. Tamayo Antabak2, J. Contarelli3, M. Michaan3, H. Laplume4, P. Scapellato5, E. Bottaro5, F. Murano6, O. Garcia Messina7, L. Massera3, M.H. Losso1
1Hospital J.M.Ramos Mejia, Inmunocomprometidos, Buenos Aires, Argentina, 2Hospital Paroissien, infectologia, Buenos Aires, Argentina, 3Hospital San Juan de Dios, infectologia, La Plata, Argentina, 4Hospital Posadas, infectologia, Buenos Aires, Argentina, 5Hospital Santojanni, infectologia, Buenos Aires, Argentina, 6Hospital P.V.de Cordero, infectologia, Buenos Aires, Argentina, 7Hospital Parmenio Piñero, infectologia, Buenos Aires, Argentina


13:30
MOPDB207
Abstract		Extensively drug-resistant tuberculosis - case analysis 2003/2007
Presented by Fernando Maltez, Portugal
F. Maltez1, P. Cachado1, T. Martins1, L. Brum2, H. Peres3, J. Machado1
1Hospital Curry Cabral, Infectious Diseases, Lisbon, Portugal, 2Instituto Ricardo Jorge, Laboratório de Micobacteriologia, Lisbon, Portugal, 3Hospital Curry Cabral, Laboratório de Micobacteriologia, Lisbon, Portugal


Rapporteur reports

Track B report by Valeria Saraceni


In this session, we learned from Thailand that screening HIV-positive patients for TB and implementing Isoniazid Preventive Therapy is feasible. Patient`s adherence remain a challenge. From Myanmar, a high TB burden country, we learned that their TB/HIV co-infection rate was heavily underestimated (10%), when a program to give HIV care to TB patients yielded a 33% rate. HIV-positive patients had worse TB outcomes than HIV-negatives, but the former performed better when they had access to HAART. In a small study from Iran, mortality related to TB in HIV-patients was reduced when HAART was initiated in patients with low CD4 (<100). Two studies, one from Spain and one from Argentina looked at TB/HIV co-infection and HAART. The first found that having TB do not impair patients` response to HAART. The other discussed starting HAART in the first 8 weeks vs. after, with a greater mortality in the former group. The last presentation from Portugal didn’t happen, but the abstract reviewed their rate of XDR-TB in patients admitted to hospitals. They found 17 cases of XDR-TB out of 595 cultures, with a 65% HIV-positivity and a low lethality rate.(2 deaths). No reports on strains or fingerprinting.

MOPDB201 -- Introduction: Interaction between HAART and TB treatment -
Jean Pape, Haiti
Dr. Pape briefly introduced the topics, talking about the importance of isonaizid preventive therapy to reduce TB incidence in HIV-positive subjects and of HAART in the survival of co-infected patients. 

MOPDB202 -- Incidences of latent and active tuberculosis among MTCT-Plus patients who received annual tuberculin skin test with isoniazid preventive therapy in Thailand: a 4-year follow up - Nittaya Phanuphak, Thailand
IPT reduces TB incidence, it’s advised, and the authors show it was feasible to implement in Thailand. Interestingly, immune restoration wasn’t associated with TST conversion in this group. Only 1 TB case occurred among the 151 that completed IPT. Adherence can be a problem, it has waned with time. Patients and health care providers should be stimulated to screen for TB and complete IPT, to be effective in reducing TB incidence.

MOPDB203 -- Epidemiological, clinical, biological characteristics and treatment outcomes of a cohort of HIV-TB patients enrolled in the integrated HIV care for tuberculosis patients program (IHC) in Mandalay, Myanmar -  Min Thwe, Myanmar
From Myanmar , a high burden TB country, came this study where a program to  integrate HIV care for TB patients was implemented. Their TB/HIV co-infection, estimated in 10%, was found to be 34% (1893) among 8080 TB patients enrolled. Overall, HIV-positive subjects had worse outcomes than HIV-negatives, but outcomes were better for those who received HAART than for those who didn’t, showing clearly the need to scale-up HAART access faster  in this population with this huge rate of TB/HIV co-infection.  

MOPDB204 -- Response to HAART in naïve patients with a diagnosis of tuberculosis - J. Del Amo, Spain
This study in Spain compared the response to HAART after a TB diagnosis or other AIDS-defining disorder (ADI) to AIDS-free subjects and found that a previous diagnosis of TB or another ADI before HAART does not compromise short-term viral and immunological response to treatment, ADI, but not TB, was associated with more than a two-fold increase in all cause mortality.

MOPDB205 -- Early initiation of antiretroviral therapy results in decreased morbidity and mortality among patients with advanced HIV disease - Payam Tabarsi, Iran, Islamic Republic of
69 patients were divided in 3 groups in Iran, and HAART was started on a small number with cd4< 100, apparently with a decrease in mortality. However, the results obtained are confounded by the mixed group with CD4< 200.  Once gain, HAART after TB is advisable.

MOPDB206 -- Early versus late cART treatment in HIV/TB co-infected patients in Argentina - Javier Jose Toibaro, Argentina
In Argentina, 142 patients were included in this study to look at HAART after TB divided in early (<8 weeks) or late (>8 weeks). The groups weren’t homogeneous at baseline and  mortality was greater in the early group, probably confounded by the independent variables differences.

MOPDB207 -- Extensively drug-resistant tuberculosis - case analysis 2003/2007 – Portugal  - NOT PRESENTED




Leadership report by Nithya Krishnan

This poster discussion intended to illustrate the deadly partnership between HIV and TB. The abstract presentations were primarily about treatment for various forms of TB, HIV and co-infected populations.   

N. Phanuphak spoke regarding the incidence of latent and active TB in PMTCT patients who received IPT therapy in Thailand. It was a longitudinal study conducted over the course of 4 years. The study  addressed the benefits and feasibility of IPT in Thailand in a group of MTCT patients that did not previously have latent or active TB and they were offered annual skin tests. A 9-month course of IPT was provided for patients with latent TB. The findings of the study were that IPT tended to reduce TB incidence as active TB occurred in only 0.3% of people that completed the therapy. IPT seemed to be a promising method of reducing and preventing active TB.

S. Moreno presented about the response to HAART in naïve patients with a diagnosis of tuberculosis. The cohorts of this study were HIV-infected adults that were classified as having a TB diagnosis, AIDS defining illness (ADI) or being event-free before HAART. The objective was to test the efficacy of pre-emptive HAART. The conclusions of this study were that in the majority of cases, a diagnosis of TB or ADI did not compromise the immunological or physiological response to HAART. Yet untreated TB or ADI reflected a two-fold increase in all cause mortality. The implications of the study are that HAART treatment before the onset of active TB and AIDS is an advantageous step in preventive treatment.

The study of early initiation of ART in was presented by P. Tabarsi. The objective was to further delineate the overlapping drug toxicity profiles in the management of TB and HIV. The patient sample consisted of two groups. Group 1 was those people that were initiated with HAART therapy 8 weeks after TB treatment with a CD4 count of <200 cells/ml, while group 2 included TB patients who were initiated with HAART after only 2 weeks of TB treatment with a CD4 count of <100. The conclusions of the study were that there were no differences between group 1 and 2 in respect to adverse drug reactions (toxicity), response to TB treatment and new opportunistic infection. In fact, death occurred more frequently in the group where HAART was started later, implying that the early initiation of HAART resulted in decreased mortality.

 J.J. Toibaro spoke of the Early versus late combination ART treatment in HIV/TB co-infected patients in Argentina. The study compares patients that started combination ART (cART) within or after 8 weeks of TB treatment. The objective is to identify the optimal timeline for initiating combination ART. The results showed that early initiation of cART within 8 weeks of TB treatment was more effective than the late cART treatment though further investigations are needed to clarify the difference in mortality.




   

   

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