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Blizard Institute - Faculty of Medicine and Dentistry
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  4. Centre for Immunobiology
  5. Queen Mary and Barts Health Tuberculosis Centre
  6. Our Research
  7. HIV-associated TB

HIV-associated TB

Immunodeficiency associated with untreated HIV dramatically increases the risk of active TB disease. In patients with HIV and low CD4 counts, TB commonly disseminates via the blood stream to multiple organs causing severe illness with sepsis syndrome. Short term mortality among such patients admitted to hospital is 20-35% despite initiation of TB treatment. Studies have investigated this high mortality and the underlying pathophysiology finding associations of disseminated Mycobacterium tuberculosis load and innate immune activation and chemotactic signalling with mortality. Ongoing work includes the Wellcome-funded NewStrat-TB trial of novel treatment strategies for patients with disseminated HIV-associated TB admitted to hospital, being conducted at 3 hospitals in Cape Town (n=732). Studies are also characterising the association of monocyte-macrophage activation and effector functions with mortality. The group also investigates diagnostics for HIV-associated tuberculosis, including recent studies evaluating the performance and diagnostic yield of the Xpert Ultra assay performed on centrifuged urine. 

Outputs

  • Schutz C, Barr D, Andrade BB, Shey M, Ward A, Janssen S, Burton R, Wilkinson KA, Sossen B, Fukutani KF, Nicol M, Maartens G, Wilkinson RJ, Meintjes G. Clinical, microbiologic, and immunologic determinants of mortality in hospitalized patients with HIV-associated tuberculosis: A prospective cohort study. PLoS Med. 2019 Jul 5;16(7):e1002840.
  • Boloko L, Schutz C, Sibiya N, Balfour A, Ward A, Shey M, Nicol MP, Burton R, Wilkinson RJ, Maartens G, Meintjes G, Barr DA. Xpert Ultra testing of blood in severe HIV-associated tuberculosis to detect and measure Mycobacterium tuberculosis blood stream infection: a diagnostic and disease biomarker cohort study. Lancet Microbe. 2022 Jul;3(7):e521-e532. 
  • Janssen S, Schutz C, Ward A, Nemes E, Wilkinson KA, Scriven J, Huson MA, Aben N, Maartens G, Burton R, Wilkinson RJ, Grobusch MP, Van der Poll T, Meintjes G. Mortality in Severe Human Immunodeficiency Virus-Tuberculosis Associates With Innate Immune Activation and Dysfunction of Monocytes. Clin Infect Dis. 2017 Jul 1;65(1):73-82. 
  • Meintjes G, Maartens G. HIV-Associated Tuberculosis. N Engl J Med. 2024 Jul 25;391(4):343-355.
  • Stead D, Wasserman S, Steenkamp E, Parrish A, Barr D, Meintjes G. Comparative Performance of Urine Lipoarabinomannan and Urine Xpert MTB/RIF Ultra for Diagnosing Tuberculosis in Adult Inpatients With Human Immunodeficiency Virus in East London, South Africa. Clin Infect Dis. 2025 Apr 2:ciaf080.

Projects

NewStrat-TB trial (Namale PE, Boloko L, Vermeulen M, Haigh KA, Bagula F, Maseko A, Sossen B, Lee-Jones S, Msomi Y, McIlleron H, Mnguni AT, Crede T, Szymanski P, Naude J, Ebrahim S, Vallie Y, Moosa MS, Bandeker I, Hoosain S, Nicol MP, Samodien N, Centner C, Dowling W, Denti P, Gumedze F, Little F, Parker A, Price B, Schietekat D, Simmons B, Hill A, Wilkinson RJ, Oliphant I, Hlungulu S, Apolisi I, Toleni M, Asare Z, Mpalali MK, Boshoff E, Prinsloo D, Lakay F, Bekiswa A, Jackson A, Barnes A, Johnson R, Wasserman S, Maartens G, Barr D, Schutz C, Meintjes G. Testing novel strategies for patients hospitalised with HIV-associated disseminated tuberculosis (NewStrat-TB): protocol for a randomised controlled trial. Trials. 2024 May 8;25(1):311)

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