Tuberculosis Clinical Trial
Official title:
Is Tuberculosis Recurrence in Treated Tuberculosis-Human Immunodeficiency Virus (HIV) Co-Infected Patients Relapse or Re-infection?
This is a cohort observational study investigating the rate of tuberculosis (TB) recurrence in adult patients who have completed TB therapy for Pulmonary TB (PTB) and are on highly active antiretroviral therapy (HAART).The primary objective of this study is to determine the incidence of TB recurrence in patients on HAART.The study is being conducted at the CAPRISA eThekwini Clinical Research Site (CRS), which is adjacent to the Prince Cyril Zulu Communicable Disease Clinic (PCZCDC), a major urban TB clinic, in Durban, South Africa.No hypotheses will be tested in this study; however, the primary study question will determine the proportion of TB recurrence due to relapse vs. re-infection.The study has enrolled 402 participants
1. Objective: To determine the extent of and reasons for relapse and re-infection in
incident cases of tuberculosis (TB) in Human Immunodeficiency Virus (HIV)-infected
patients on Highly Active Antiretroviral Therapy (HAART)
2. Design: A prospective cohort study of patients with HIV previously treated for
pulmonary TB and initiated on HAART in the SAPIT (Starting AIDS treatment at three
Points in TB treatment) and START (Starting Tuberculosis and Anti-Retroviral Therapy)
trials. Each incident case of TB recurrence in this cohort of adult patients on HAART
will be investigated to assess whether the infecting mycobacterium is similar to that
from the previous infection and whether the immune responses differ in cases of relapse
and re-infection.
3. Population: Men and women 18 years of age with documented HIV infection and past TB
therapy as part of the SAPIT and START trial will be enrolled.
4. Study Procedures: This study will involve 3 years of follow-up of patients who had been
initiated on a course of TB therapy as part of the SAPIT and START trials. Upon exit
from the SAPIT trial (i.e. 18 months post-TB diagnosis), study patients will be
consented and enrolled in this cohort study. Study participants will be seen monthly
for the first 3 months and thereafter 3 monthly, for routine clinic visits and ART
services. At every visit patients will be screened for TB recurrence clinically, with
chest radiograph and, whenever possible, with available TB diagnostics or new
diagnostics that are being developed and/or tested.
5. Study Outcome The primary endpoint of this study will be the development of recurrent
TB. TB recurrence as a result of relapse will be defined as isolates of M. tuberculosis
from the first and second episodes of TB which cluster in Restriction Fragment Length
Polymerization (RFLP) analysis. TB recurrence as a result of re-infection will be
defined as isolates from the first and second episode of TB which differ on RFLP
analysis. Each study participant who has recurrent TB will be assessed by Interferon
(IFN) gamma ELISPOT assay to compare cytotoxic lymphocyte (CTL)immune responses in TB
relapse and re-infection.
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