TB/HIV Working Group

Summary of the TB/HIV Research Frontiers meeting

CROI 2010, San Francisco, USA

The Stop TB Department of the World Health Organization and the Consortium to Respond Effectively to the AIDS/TB Epidemic organized an HIV/TB research frontiers meeting on behalf of the TB/HIV Working Group of the Stop TB Partnership affiliated with the 17th Conference on Retroviruses and Opportunistic Infections (CROI 2010) in San Francisco, USA on February 16, 2010 . This is the fourth in a series of meetings organized by WHO and CREATE since 2007. The meeting was co-chaired by Dr Kenneth Castro , Assistant Surgeon General and Director of Division of Tuberculosis Elimination  Centers for Disease Control and Prevention and Dr Alison Grant , Head of the Clinical Research Unit in London School of Hygiene and Tropical Medicine. The meeting was opened by Dr Diane Havlir, the chair of the TB/HIV Working Group who described the popularity of the meetings among HIV researchers to stimulate scientific debates and discussions around HIV/TB. The meeting was attended by more than 65 HIV researchers and public health policy makers.

The main objective of the meeting was to promote high level scientific interchange of ideas and debates around isoniazid preventive therapy (IPT) and its role in improving survival among people living with HIV so as to generate questions for future research. New data on the impact of IPT on mortality of people living with HIV was presented from Botswana, India and South Africa. Dr Craig Innes (Innes_San Francisco CROI 2010) , from Aurum Institute of South Africa presented the result of a retrospective observational study of more than 3200 patients on ART, which shows the combined use of IPT and ART may reduce the risk of death by nearly 50%. Dr Soumya Swaminathan (Swaminathan_San Francisco CROI 2010) from the TB Research Center in Chennai, India presented a randomized controlled trial with a sample size of 752 that compares 6 month INH and Ethambutol versus 36 month INH which showed no statistically significant difference in mortality in both arms. She said most of the mortality occurred during the first 12 months and there was no difference in mortality based on tuberculin skin test (TST) status. Dr Taraz Samandari from CDC presented a preliminary report of mortality from the Botswana IPT randomized controlled trial with a sample size of 2000 that compares 6 month IPT versus 36 months. He reported that there was non-significant increase in mortality in the 36 months arm than the 6 months. They observed three fold increased death in TST negatives as compared to TST positives, in contrast to the Indian trial. However, further clinical characterization of the two deaths that were attributed to hepatic encephalopathy (observed among TST negatives) was not conclusive. Dr Richard Chaisson of John Hopkins and CREATE provided commentary on the role of IPT and mortality and underscored the primary objective of IPT is to prevent TB rather than improving survival. He stated the reasons for absence of significant gain in survival out of IPT including most studies are not powered to look survival benefit and patients enrolled in the trials are often not those with advanced stage of disease and are under active surveillance and follow-up.

Dr Haileyesus Getahun (Getahun_San Francisco CROI 2010) of WHO presented the outcome of a primary patient meta-analysis that was done to develop a rule to screen people living with HIV to put them on IPT and further investigations for TB or other diseases. He also shared the upcoming draft WHO recommendations on IPT and intensified TB screening among people living with HIV.

Dr Alison Grant (Grant_San Francisco CROI 2010) of London School presented on the role of IPT in settings with high rates of drug resistance TB. She presented summary of the evidence and stated that IPT does not promote drug resistance TB and actually protection from IPT no is no worse with a background of INH resistance. However, she stated that there is scanty information that IPT may be less ineffective in individuals with latent INH resistant TB. There is no evidence about threshold prevalence of INH resistance at which IPT risks exceed benefits. Similarly there is no data on what to do for contacts with MDR TB cases and the available international guidelines are not consistent to each other. She suggested placebo controlled trials for MDR contacts using drugs like high dose INH, fluoroquinolones or new agents (e.g. TMC 207).

From Mekong to Bali: the scale up of collaborative TB/HIV activities in Asia Pacific Region. 8-9 August, 2009, Bali, Indonesia.

Catalyzing the implementation of collaborative HIV/TB activities in the Asia and Pacific regions is a key priority. This region has more than half of the global burden of TB and 12% of the global burden of HIV. To this end the meeting "From Mekong to Bali: scale up of HIV/TB collaborative activities in Asia Pacific" was organized by the World Health Organization (WHO) in collaboration with the HIV/TB Working Group of the Stop TB Partnership. 127 people from 18 countries participated in the meeting with representation from all high TB and HIV burden countries. Participants shared experiences and best practices to inform plans to accelerate the implementation of nation-wide scale up of collaborative HIV/TB activities. The meeting followed on from the first regional HIV/TB meeting held in the Mekong sub region in Ho Chi Minh City, Vietnam in October 2004. National TB and HIV program managers were joined by a broad range of AIDS and TB stakeholders active in the Asia and Pacific regions, members of the HIV/TB Working Group and representatives of bilateral and multilateral organizations, NGOS, and faith based organizations. The presentations and posters from the meeting are available below. The final meeting report will be available in due course.

TB/HIV at IAS 2009: Catalysing HIVT/TB Research: innovation, funding and networking

The World Health Organization and the TB/HIV Working Group of the Stop TB Partnership in collaboration with the Consortium to Respond Effectively to the AIDS/TB Epidemic (CREATE), International AIDS Society, Treatment Action Group and the Desmond Tutu HIV Centre of University of Cape Town organized a highly visible meeting in conjunction with the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town, South Africa on July 18-19, 2009.

The meeting was attended by about 250 HIV researchers, activists and representatives from funding agencies. The meeting focused on critical TB/HIV issues in the areas of TB prevention, diagnosis and treatment, childhood TB and drug resistant TB. New and previously unreported data was shared, discussed and research priorities were defined. The research priority discussions during the meeting also informed the ongoing revision of the TB/HIV research priorities agenda. The outcome and key findings of the meeting were communicated to IAS conference delegates through a satellite symposium on July 21, 2009. Report of the meeting will be available soon.

July 21, 2009

July 19, 2009

Watch Dr. Barré-Sinoussi's plenary presentation

Read the presentations made at the meeting

July 18, 2009

Watch Dr. Fauci's plenary presentation

TB/HIV at CROI 2009

The Stop TB Department of WHO in collaboration with the Consortium to Respond Effectively to the AIDS/TB Epidemic (CREATE) organized a meeting affiliated with the 16th Conference on Retroviruses and Opportunistic Infections (CROI 2009) in Montreal, Canada. This is the third in a series of meetings organized since 2007.

The meetings have successfully raised the profile of HIV/TB among HIV researchers in particular by sharing data from ongoing studies, identifying research gaps and stimulating further HIV/TB research. The main objective of the meeting at CROI 2009 was to promote high level scientific interchange of ideas and research priorities to have a better understanding of the magnitude and burden of TB (including drug resistant strains) especially in HIV prevalent settings.

Read the presentations made at the meeting

PK and Drug Interactions in a Changing World: New Drugs for TB and New Regimens for TB-HIV Co-infection by Charles Flexner, MD, Johns Hopkins University

Treatment of Extensively Drug Resistant Tuberculosis Among Patients with HIV Infection in South Africa by Max O’Donnell , Nesri Padayatchi, Iqubal Master, Garth Osburn, Robert Horsburgh

Sensitivity, specificity and predictive values of symptoms to detect tuberculosis in the ZAMSTAR community based prevalence studies by Peter Godfrey-Faussett and Helen Ayles, London School of Hygiene and Tropical Medicine, UK