There is life with HIV

The three-drug regimen outperforms XDR-TB in the first test

I consider this text very important for several reasons ... One of them is that I was a carrier and latent tuberculosis and, even without having a place to live, I had to keep the treatment up to date or I would give rise to an active tuberculosis infection and this Could become a tiny tuberculosis, and with the countless number of last-minute deserters, having active tuberculosis and living on the street was not a good idea.

I remembered the Abreugrafia for mere fortuitousness. Today, there is no longer this need to have an abbreviation attesting that you do not have tuberculosis, then tuberculosis, or TB, like a nurse ... you did not understand the designation.

I remember the usual scenario, there on the slope of memory, near the slope of memory (there are hillside, ah slope) with posters offering rude at reasonable prices and I did there at 11 years, my first abreugrafia, that Was tiny, in a paper wallet, as fragile as the people who tried to be an endemic doe, which was an obstacle to getting a job card ...

I took a very short excerpt from Wikipedia and put it here:

Abreugrafia
This was the X-ray. Maybe it was seven inches high, 5 and width, who could get it felt like the people who earned the right to go to the "OFSHORE" in the series that I left, the 3%

Abreugrafia Is the name given in the Brazil A cheap and quick method of taking small lungs, To facilitate the diagnosis of TB, Deadly disease. The test, which records the chest image on a X ray, Has spread throughout the world.

The inventor of the examination, Manuel Dias de Abreu, Was Nobel In 1950 and had the invention baptized in his honor in Brazil. In other countries, the exam was called "schermografia" (Italy), "Roentgenfotografia" (Germany) And photofluorography (France). In Brazil, on January 4 (04 / 01) the "National Day of Abreugrafia" is celebrated,[1].

Three drugs together outperformed XDR-TB

Green puldmos
It would be nice if we could have lungs like that, free of the smell and smoke of cigarettes, which I'm giving up, and the smoke from cars, trucks and mills like the stupid one wants to revive

Although I see a remarkable lack of interest from people with HIV in tuberculosis, it is necessary to reiterate that this combination "AIDS / Tuberculosis" is one of the most fateful co-infections for people living with HIV or AIDS.

The girl I got HIV from had had tuberculosis before she met me and told me that. If I was just a little better informed, I would have lit all the yellow lights in my brain and, I believe, I would have used condoms with her, but, frankly, sex was such a crazy thing that I would eventually forget about the blessed condom And in this way nothing would have changed and I would also be here writing this article and casting my favorite phrase to console people and, I well know, the day will come when I, for one reason or another, will have to look at My image in the mirror and say, with a smile on my face:

"Claudio! ... Everything is as God desires"! .... And I'll still have to smile

And it is on the basis of this that I return, after more than two years without publishing anything about tuberculosis, to publish a text, which will be followed by others, also on Tuberculosis, but not lined up one after the other. In short, important things in the editorial line of this site, which I "forgot", will temporarily come back.

What I wanted to leave as a warning shot is that every person who is diagnosed with tuberculosis should be tested for HIV. I am not stigmatizing people with Tuberculosis, the point is that these two conditions often go hand in hand and in the other way, every diagnosed person who is not tested and who has not been tested for tuberculosis should do so as soon as possible. Because of the kisses and hugs that I exchanged with my girlfriend, and what kisses, made me a latent tuberculosis carrier and I had to maintain my preventive therapy for eighteen months, even when, not enough disgrace I still went back to To live in the streets, by personal choice, because the Houses of Support in which I lived, they wanted me to be a statistic, and they forbade me from looking for a job ... But this is another story

 

Nix-TB patient in waiting area at Brooklyn Chest Hospital in Cape Town. Credit: John-Michael Maas for TB Alliance.
Nix-TB patient in waiting area at Brooklyn Chest Hospital in Cape Town. Credit: John-Michael Maas for TB Alliance.

A regimen of three oral medications administered for six months was sufficient to eliminate Drug-resistant tuberculosis (XDR-TB) in 29 of the first 31 people to complete the entire course of treatment, Dr. Francesca Conradie of Sizwe Tropical Disease Hospital in Johannesburg 2017 Conference on Retroviruses and Opportunistic Infections (CROI). If the results are replicated in a larger population, the results could revolutionize The prospects for treatment not only of XDR tuberculosis, but also of the more severe cases of MDR (multidrug-resistant tuberculosis) tuberculosis.

XDR-TB is a growing problem in countries with an MDR-TB endemy, such as South Africa. XDR-TB is TB Which is resistant to isoniazid and rifampicin, plus any fluoroquinolone and at least one of the three injectable second-line drugs (Example: amikacin, kanamycin or capreomycin). MDR-TB is TB that is resistant to isoniazid and rifampicin.

XDR-TB Transmission

Although XDR-TB may be a consequence of failure to treat MR-TB, Research in South Africa has shown that transmission between people, often outside the home, is the main

R of the country's growing XDR tuberculosis. In addition, research presented this week at CROI shows that migration and travel play an important role in the spread of XDR-TB in South Africa's most affected province, KwaZulu-Natal.

Kristin Nelson from Emory University
Kristin Nelson - Photo Twitter

Kristin Nelson of Emory University, Atlanta, shared results from a study that sought to identify the geographic locations of individuals with genetically-linked XDR TB infections. The study was designed to determine if specific sites were strongly implicated in the spread of XDR-TB. Surprisingly, the researchers found that the average distance between people's homes in these genetically linked pairs was 111 km and 83% of people in genetically linked pairs lived in different districts of the province. A very high level of mobility for work, the demand for health care and for family reasons seems to be contributing to the spread of XDR-TB. Home transmission, traditionally considered the most important arena of TB transmission and the focus of account tracking and case detection efforts, appears to be less important than previously predicted.

XDR-TB Treatment

Current treatment for XDR-TB requires the assembly of a six-drug regimen, including a six-month treatment phase that includes injectable drugs and other 12-18 months of treatment with five drugs. Some of the drugs used to treat both MDR-TB and XDR-TB have serious side effects, including hearing loss and kidney damage in the case of various injectable drugs. Some drugs used in the regime are costly and unavailable in some countries, further complicating the setting up of an effective regime that is absolutely necessary. Interrupting this treatment means that the space for the etiological agent adapts to resistance to this drug, and may lead to an outbreak of a NEW TYPE OF TUVERCULOSIS, which could become an epidemic (perhaps an endemic disease with proportions that I, Claudio Souza, can not Imagine even in my worst nightmare)

Even if people have access to XDR-TB treatment and are able to tolerate the regimen, the cure rate is shockingly low. Follow-up of people treated for XDR-TB in South Africa between 2008 and 2012 Shows that only 11% had achieved cure five years after starting treatment, While 73% of the patients died.

Finding a shorter duration regimen that is effective against XDR-TB, with fewer serious side effects, would improve the chances of treating the infection and disrupting the chain of transmission.

The NIX-TB trial tests a three-drug regimen consisting of bilequilin (Sirturo) (The first new anti-TB drug to be approved in 40 years), linezolid (an inexpensive antibiotic), and pretomanid (PA-824), an experimental drug against tuberculosis developed by the Alliance of TB.

Francesca Conradie presented results in the first 72 people to be treated in the study.

Participants were eligible to join the study if they had documented XDR-TB or were intolerant to an MDR-TB regimen and remained culture-positive or had no cure for MDR-TB treatment and remained positive for the culture. Persons with HIV who had a CD4 cell count of less than 50 cells / mm 3, And people with cardiac arrhythmia or severe peripheral neuropathy.

Of the 72 participants, 51% were HIV positive, 65% had XDR-TB, 24% had TB-MR treatment insufficiency and 11% were intolerant to MDR-TB treatment. Participants were divided equally by gender (54% male) and predominantly black (78%).

Treatment is ongoing for some participants, so the participants' mood is as follows:

  • 72 people started treatment
  • 4 people died during treatment (3 due to disseminated TB - miliary tuberculosis, common in people with HIV and low counts of CD4 - and due to gastrointestinal bleeding)
  • 28 people are still asob treatment
  • 40 people completed the initial course of 6 months of treatment
  • Of these, 31 people completed treatment and 6 months post-treatment follow-up.

Of the 31 who completed post-treatment follow-up, 29 people eradicated XDR-TB from their organisms. One person was reinfected with drug-susceptible TB. Another person appears to have experienced a relapse of XDR-TB, but genome sequencing is needed to determine if this is a true case of relapse, or if it is a reinfection.

Cultural conversion was uniformly rapid for a population with drug-resistant TB. All participants were culture negative within four months of starting treatment, and 26 of the 40 people who completed the treatment were culture negative at the 8 week of treatment.

Adverse effects during treatment were mainly attributable to linezolid and 49 of the 60 people who remained on treatment to date discontinued the linezolid dose at least once. In 14 cases, dose discontinuation was due to myelosuppression (decreased production of blood cells and platelets in the bone marrow, a side effect of some cytotoxic drugs), and in 28%, dose discontinuation was due to pain Peripheral neuropathy.

Dr. Conradie said that peripheral neuropathy pain can be managed with gabapentin, but that it gradually subsides after treatment is completed.

The definition of Myelosuppression (The definition of this term was found in a Roche's glossary.

Translated by Cláudio Souza from the original redigioo by Keith Alcor In Three-drug regimen beats XDR-TB in first trial

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