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Background: Diabetes mellitus (DM) is a well-established risk factor for active tuberculosis (TB) infection. Despite the worldwide rapid increase in the prevalence of prediabetes, its impact on the risk of active TB remains largely unknown. This study aimed to investigate the relationship between prediabetes and risk of active TB in a large cohort study.Methods: A total of 119 352 participants were screened from a community-based health screening programme in Northern Taiwan. Diabetes mellitus and prediabetes were defined by baseline fasting plasma glucose (FPG) and prescription of anti-diabetic drugs. Incident cases of active TB were identified from the National Tuberculosis Registry. Kaplan-Meier curves and Cox regression analysis were employed to estimate the hazard ratios for prediabetes and DM compared with normoglycaemia. Spline regression was performed to investigate the dose-response relationship between FPG level and risk of TB disease.Results: At baseline, 27 404 (22.96%) participants had prediabetes and 10 943 (9.17%) participants had DM. After an average follow-up of 7.2 years, 322 TB cases occurred. The adjusted hazard ratio of developing active TB disease was 0.73 [95% confidence interval (CI) 0.55-0.97] for prediabetic and 1.48 (95% CI 1.11-1.98) for diabetic participants compared with normoglycaemic individuals. Spline regression revealed a U-shaped association between FPG level and risk of active TB disease, with the lowest risk at FPG around110 mg/dl. Sensitivity analyses were conducted to exclude factors such as potential confounders (including body mass index), misclassification of glycaemic level, and selection bias, and results showed that those factors could not explain the lower risk of active TB.Conclusions: Prediabetes was associated with a 27% reduced risk of active TB disease compared with normoglycaemia. The biological mechanism of this inverse association and its implication for global nutrition transition and TB control should be further investigated. [ABSTRACT FROM AUTHOR]

Objective To assess the effect of tobacco smoking on the outcome of tuberculosis treatment in Tbilisi, Georgia. Methods We conducted a prospective cohort study of adults with laboratory-confirmed tuberculosis from May 2011 to November 2013. History of tobacco smoking was collected using a standardized questionnaire adapted from the global adult tobacco survey. We considered tuberculosis therapy to have a poor outcome if participants defaulted, failed treatment or died. We used multivariable regressions to estimate the risk of a poor treatment outcome. Findings Of the 591 tuberculosis patients enrolled, 188 (31.8%) were past smokers and 271 (45.9%) were current smokers. Ninety (33.2%) of the current smokers and 24 (18.2%) of the participants who had never smoked had previously been treated for tuberculosis (Pc 0.01). Treatment outcome data were available for 524 of the participants, of whom 128 (24.4%)--including 80 (32.9%) of the 243 current smokers and 21 (17.2%) of the 122 individuals who had never smoked--had a poor treatment outcome. Compared with those who had never smoked, current smokers had an increased risk of poor treatment outcome (adjusted relative risk, aRR: 1.70; 95% confidence interval, CI: 1.00-2.90). Those who had ceased smoking more than two months before enrolment did not have such an increased risk (aRR: 1.01 ; 95% CI: 0.51-1.99). Conclusion There is a high prevalence of smoking among patients with tuberculosis in Georgia and smoking increases the risk of a poor treatment outcome. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] Objectif Evaluer l'effet du tabagisme sur les resultats des traitements antituberculeux a Tbilissi, en Georgie. Methodes Nous avons realise une etude de cohorte prospective chez des adultes atteints de tuberculose confirmee en laboratoire, de mai 2011 a novembre 2013. Les antecedents de tabagisme ont ete recueillis a l'aide d'un questionnaire standardise, adapte de l'enquete mondiale sur le tabagisme des adultes. Nous avons considere que les resultats du traitement antituberculeux etaient mauvais si les participants ne l'avaient pas respecte, n'avaient pas repondu au traitement ou etaient decedes. Nous avons utilise des regressions multivariees pour estimer le risque de mauvais resultats therapeutiques. Resultats Sur les 591 patients atteints de tuberculose, 188 (31,8%) etaient d'anciens fumeurs et 271 (45,9%) fumaient encore. Quatrevingt-dix (33,2%) fumeurs actuels et 24 (18,2%) participants n'ayant jamais fume avaient precedemment pris un traitement contre la tuberculose (P Conclusion Il existe une forte prevalence de tabagisme chez les patients atteints de tuberculose en Georgie et le tabagisme augmente le risque de mauvais resultats therapeutiques. [TEXT NOT REPRODUCIBLE IN ASCII] Objetivo Evaluar los efectos del consumo de tabaco en los resultados del tratamiento de la tuberculosis en Tbilisi, Georgia. Metodos Se llevo a cabo un estudio de cohortes prospectivo en adultos con tuberculosis confirmada mediante pruebas de laboratorio de mayo de 2011 a noviembre de 2013. Se recopilo Informacion sobre el consumo de tabaco mediante un cuestionario normalizado adaptado a partirde la Encuesta Mundial sobre elTabaco y los Adultos. Se considero que los resultados de la terapia antituberculosa eran deficientes si los participantes incumplian el tratamiento, no lo realizaban o morian. Se utilizaron regresiones multivariables para estimar el riesgo de obtener unos resultados deficientes del tratamiento. Resultados De los 591 pacientes con tuberculosis inscritos, 188 (31,8%) eran antiguos fumadores y 271 (45,9%) eran fumadores actuales. Noventa (33,2%) de los fumadores actuales y 24 (18,2%) de los participantes que no habian fumado nunca habian recibido tratamiento para la tuberculosis anteriormente (P < 0,01). Los datos sobre los resultados del tratamiento estuvieron disponibles para 524 de los participantes, de los cuales 128 (24,4%) (incluyendo los 80 (32,9%) de los 243 fumadores y 21 (17,2%) de las 122 personas que nunca habian fumado) obtuvieron unos resultados deficientes del tratamiento. En comparacion con las personas que no habian fumado nunca, los fumadores actuales tenian un riesgo superior de obtener unos resultados deficientes del tratamiento (riesgo relativo ajustado, RRa: 1,70; intervalo de confianza, IC, del 95%: 1,00-2,90). Aquellas personas que habian dejado de fumar mas de dos meses antes de la Inscripcion no experimentaban un aumento del riesgo tan elevado (RRa: 1,01 (IC del 95%: 0,51-1,99). Conclusion Existe una elevada prevalencia de consumo de tabaco entre los pacientes con tuberculosis en Georgia y el consumo de tabaco aumenta el riesgo de obtener unos resultados deficientes del tratamiento., Tabagisme et resultats des traitements antituberculeux : etude de cohorte prospective en Georgie El consumo de tabaco y los resultados del tratamiento de la tuberculosis: un estudio de cohortes prospectivo [...]

The World Health Organization (WHO) reported that control efforts are off-track in managing multidrugresistant tuberculosis (MDR TB) and that addressing this problem is a priority (1). In 2013, WHO estimated [...]

Background Hepatitis C virus (HCV) and hepatitis B virus (HBV) coinfection are associated with increased mortality in people with HIV (PWH), and hyperglycemia is a common comorbidity in PWH. In this study, we used routinely collected clinical data to assess the associations between HBV and HCV seropositivity with all-cause mortality and whether this relationship differs by hyperglycemia status. Methods Eligible participants included adult PWH (≥15 years) who initiated antiretroviral therapy between May 2005 and June 2016 in Myanmar. HBV and HCV serostatus and hyperglycemia were measured at enrollment to HIV care using HBV surface antigen, HCV antibody tests, and random blood glucose (≥140 mg/dL), respectively. Results Among 27 722 PWH, 2260 (8%) were HBV seropositive, 2265 (9%) were HCV seropositive, 178 (0.6%) were HBV-HCV seropositive, and 1425 (5%) had hyperglycemia. During the median follow-up (interquartile range) of 3.1 (1.5–5.1) years, 3655 (13%) PWH died, and the overall mortality rate was 3.8 (95% CI, 3.7–3.9) per 100-person-years (PY). The mortality rate (per 100 PY) among PWH who were HBV seropositive was 4.6, among PWH who were HCV seropositive it was 5.1, and among PWH who were HBV-HCV seropositive it was 7.1. When stratified by glycemic status, the mortality rate was higher among patients with hyperglycemia compared with those with euglycemia (5.4 vs 4.0 per 100 PY), and the difference in mortality rate between patients with hyperglycemia and euglycemia was highest among those with HCV seropositivity (9.8 vs 5.0 per 100 PY). Conclusions Increased mortality rates associated with HBV and HCV seropositivity in PWH differed by their glycemic status. PWH with HCV seropositivity and hyperglycemia had the highest mortality rates. [ABSTRACT FROM AUTHOR]

Objective: In cross-sectional U.S. studies, patients with diabetes had twice the prevalence of latent tuberculosis infection (LTBI) compared with those without diabetes. However, whether LTBI contributes to diabetes risk is unknown. We used longitudinal data to determine if LTBI is associated with increased diabetes incidence.Research Design and Methods: We conducted a retrospective cohort study among U.S. Veterans receiving care in the Veterans Health Administration from 2000 to 2015. Eligibility included all patients without preexisting diabetes who received a tuberculin skin test (TST) or interferon-γ release assay (IGRA). We excluded patients with a history of active TB and those diagnosed with diabetes before or within 2 years after LTBI testing. Patients were followed until diabetes diagnosis, death, or 2015. LTBI was defined as TST or IGRA positive. Incident diabetes was defined by use of ICD-9 codes in combination with a diabetes drug prescription.Results: Among 574,113 eligible patients, 5.3% received both TST/IGRA, 79.1% received TST only, and 15.6% received IGRA only. Overall, 6.6% had LTBI, and there were 2,535,149 person-years (PY) of follow-up after LTBI testing (median 3.2 years). The diabetes incidence rate (per 100,000 PY) was greater in patients with LTBI compared with those without (1,012 vs. 744; hazard ratio [HR] 1.4 [95% CI 1.3-1.4]). Increased diabetes incidence persisted after adjustment for covariates (adjusted HR [aHR] 1.2 [95% CI 1.2-1.3]) compared with those without LTBI. Among patients with LTBI, diabetes incidence was similar in those treated for LTBI compared with those who were not treated (aHR 1.0 [95% CI 0.9-1.1]).Conclusions: Comprehensive longitudinal data indicate that LTBI is associated with increased diabetes incidence. These results have implications for people with LTBI, ∼25% of the global population. [ABSTRACT FROM AUTHOR]

Background Among pediatric patients with multidrug-resistant tuberculosis (MDR-TB), limited data exist regarding treatment outcomes in the context of the new and repurposed second-line TB drugs (SLDs). We aimed to describe the treatment outcomes among pediatric MDR-TB patients receiving new and repurposed SLDs including the proportion who achieved favorable outcomes. Methods We conducted a retrospective cohort study among pediatric patients (age ≤18 years) treated for MDR-TB in the country of Georgia from 2009 to 2016. A "new and repurposed" SLD regimen was defined as a regimen that included linezolid, bedaquiline, and/or delamanid. Favorable treatment outcome was defined by treatment completion or documented microbial "cure" status at the end of treatment. We assessed the association between the use of the new and repurposed SLDs with MDR-TB treatment outcomes using bivariate analyses and log-binomial regression. Results There were 124 pediatric MDR-TB patients (median age: 13.7; interquartile range: 4.6-16.0) initiating treatment; 119 (96.0%) had a treatment outcome recorded and were included in our analyses. Eighteen (15.1%) patients received new and repurposed SLDs from 2015 or later. After adjusting for potential confounders, the proportion achieving favorable MDR-TB treatment outcomes was higher among patients treated with SLD regimens that included new and/or repurposed drugs when compared with those treated without (adjusted risk ratio: 1.17; 95% confidence interval: 0.51-2.72). Conclusions We observed a high proportion of favorable treatment outcomes among pediatric patients with MDR-TB receiving the new and repurposed SLDs. Further studies to evaluate the efficacy and children's tolerability of the new and repurposed SLDs are still warranted. [ABSTRACT FROM AUTHOR]