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Current Opinion in HIV and AIDS

Justine Fargher, Anja Reuter, Jennifer Furin
PURPOSE OF REVIEW: More than two billion people are infected with Mycobacterium tuberculosis and few of them are ever offered therapy in spite of such treatment being associated with reduced rates of morbidity and mortality. This article reviews the current recommendations on the diagnosis and treatment of TB infection (or what is commonly referred to as 'prophylaxis' or 'preventive therapy' of latent TB) and discusses barriers to implementation that have led to low demand for this life-saving therapeutic intervention...
November 6, 2018: Current Opinion in HIV and AIDS
Ilesh V Jani, Caroline De Schacht
PURPOSE OF REVIEW: This article aims at examining the key recent advances in the field of EID, as well as at discussing approaches for resolving the major bottlenecks faced by health systems in the identification and linkage to care of HIV-infected infants. RECENT FINDINGS: Programmatic experience in South Africa and research in other high-burden countries showed that birth HIV testing is accurate, feasible and has the potential to decrease infant mortality. Substantial evidence has mounted on the accuracy of point-of-care testing for EID, including for birth testing...
November 1, 2018: Current Opinion in HIV and AIDS
Charles Flexner, David L Thomas, Susan Swindells
PURPOSE OF REVIEW: Long-acting parenteral drug delivery is an established and widely accepted solution to the problem of poor adherence when daily oral medications are used to treat or prevent chronic medical conditions. Poor adherence to oral formulations remains a major barrier to successfully treating or preventing HIV, tuberculosis (TB), and viral hepatitis. The uptake of long-acting formulations developed for these infections is uncertain, despite their promise. This review addresses the current state of development of long-acting and extended-release approaches to HIV, TB, and viral hepatitis in the context of creating market demand for such products...
November 1, 2018: Current Opinion in HIV and AIDS
Peter Ehrenkranz, Anna Grimsrud, Miriam Rabkin
PURPOSE OF REVIEW: Differentiated service delivery (DSD) has emerged as an approach for HIV programs seeking to better serve the needs of people living with HIV, reduce unnecessary burdens on the health system, and improve client outcomes. We reviewed recent evidence that addresses the challenge of DSD scale-up. RECENT FINDINGS: Most current evidence focuses on treatment of clinically stable adult clients in high HIV prevalence settings. Nonetheless, a growing body of research is emerging on how the concept of differentiation is being applied to HIV testing, linkage, and initiation; service delivery to specific demographic groups including key populations - MSM, people who inject drugs, people in prisons, sex workers, and transgender people; service delivery to adolescents and pregnant women; and impact on related medical conditions like advanced HIV...
November 1, 2018: Current Opinion in HIV and AIDS
Emily MacLean, Kavitha Saravu, Madhukar Pai
PURPOSE OF REVIEW: Diagnosis of tuberculosis (TB) in people living with HIV (PLHIV) remains a challenge, despite it being the most common comorbidity in this group. In this review, we provide an overview of tests for active TB, and their diagnostic performance in PLHIV. RECENT FINDINGS: New and updated diagnostic tests have better performance than traditional bacterial culture or smear microscopy in PLHIV. Recent developments in molecular tests have improved the sensitivity at which TB and drug susceptibility can be detected in PLHIV...
October 20, 2018: Current Opinion in HIV and AIDS
Nathan Ford, Dermot Maher, Molebogeng Xheedha Rangaka, Annabel Baddeley, Satvinder Singh, Haileyesus Getahun
PURPOSE OF REVIEW: Guidelines developed by the WHO aim to provide recommendations to support best practice in health delivery, with a focus on low-income and middle-income countries. As part of the guideline development process, critical knowledge gaps are identified and one of the core functions of WHO guidelines is to set forth priorities for future research. A review of research priorities identified through the WHO guideline development has recently been promoted as one approach to building an overarching priority research agenda in a given area...
November 2018: Current Opinion in HIV and AIDS
Betina Durovni, Solange Cavalcante
PURPOSE OF REVIEW: Tuberculosis (TB) remains the leading cause of death in people living with HIV (PLHIV) despite the achievements in antiretroviral therapy coverage. TB preventive therapy (TPT) has proved efficacy but has been neglected and poorly implemented. We reviewed recent publications and guidelines about TPT in PLHIV. RECENT FINDINGS: High-quality studies showed that TPT has a durable effect, over 5 years, preventing TB and all-cause mortality. There is new evidence showing the noninferiority of shorter, rifamycin-based regimens of TPT increasing the options for treatment...
November 2018: Current Opinion in HIV and AIDS
Alexander Kay, Anthony J Garcia-Prats, Anna Maria Mandalakas
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...
November 2018: Current Opinion in HIV and AIDS
Rocío M Hurtado, Daniel Meressa, Anne E Goldfeld
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...
November 2018: Current Opinion in HIV and AIDS
Elsa du Bruyn, Nashied Peton, Hanif Esmail, Patrick J Howlett, Anna K Coussens, Robert J Wilkinson
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...
November 2018: Current Opinion in HIV and AIDS
April C Pettit, Bryan E Shepherd, Timothy R Sterling
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...
November 2018: Current Opinion in HIV and AIDS
Michael E Herce, Monde Muyoyeta, Stephanie M Topp, German Henostroza, Stewart E Reid
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...
November 2018: Current Opinion in HIV and AIDS
Reuben Granich, Somya Gupta
PURPOSE OF REVIEW: The HIV and Mycobacterium tuberculosis syndemic remains a major global public health threat. HIV and tuberculosis (TB) global targets have been set. Success will depend on achieving combined disease control. We explore current policy, economic investment, and disease control strategies for HIV, TB, and HIV-associated TB. We review published HIV, TB, and HIV-associated TB data for 30 WHO priority countries and propose a comprehensive HIV and TB care continua. RECENT FINDINGS: In 2016, people living with HIV (PLHIV) on antiretroviral treatment (ART) ranged from 13 to 84%; viral suppression ranged from 21 to 79%...
November 2018: Current Opinion in HIV and AIDS
Naomi F Walker, Cari Stek, Sean Wasserman, Robert J Wilkinson, Graeme Meintjes
PURPOSE OF REVIEW: Antiretroviral therapy (ART) is an essential, life-saving intervention for HIV infection. However, ART initiation is frequently complicated by the tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) in TB endemic settings. Here, we summarize the current understanding highlighting the recent evidence. RECENT FINDINGS: The incidence of paradoxical TB-IRIS is estimated at 18% (95% CI 16-21%), higher than previously reported and may be over 50% in high-risk groups...
November 2018: Current Opinion in HIV and AIDS
Susan E Dorman
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...
November 2018: Current Opinion in HIV and AIDS
Jeffrey A Tornheim, Kelly E Dooley
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...
November 2018: Current Opinion in HIV and AIDS
Elisa Nemes, Thomas J Scriba, Mark Hatherill
PURPOSE OF REVIEW: To outline the need for a new tuberculosis (TB) vaccine; challenges for induction of vaccine-mediated protection in HIV-infected persons; and recent advances in clinical development. RECENT FINDINGS: HIV has a detrimental effect on T-cell function, polarization and differentiation of Mycobacterium tuberculosis (Mtb)-specific T cells, Mtb antigen presentation by dendritic cells, and leads to B-cell and antibody-response deficiencies. Previous observations of protection against TB disease in HIV-infected persons by Mycobacterium obuense suggest that an effective vaccine against HIV-related TB is feasible...
November 2018: Current Opinion in HIV and AIDS
Christine Rouzioux, Pauline Trémeaux, Véronique Avettand-Fenoël
PURPOSE OF REVIEW: A number studies are currently underway to develop new drugs aimed at reducing the HIV reservoir or achieving ART-free control of HIV infection. Many markers of HIV reservoirs have been proposed, each one having a different meaning. Total HIV DNA dynamics during the course of HIV infection and its predictive value are now well known. This marker allowed to estimate the size of HIV reservoir at different stages of HIV infection in blood, cell subsets and tissues. Therefore, the purpose of this review is timely and relevant, with the objective to discuss how total HIV DNA might be helpful in the clinical settings...
September 2018: Current Opinion in HIV and AIDS
Nir Eyal, Lisa G Holtzman, Steven G Deeks
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...
September 2018: Current Opinion in HIV and AIDS
Timothy J Henrich, Jean-Daniel Lelièvre
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September 2018: Current Opinion in HIV and AIDS
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