Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT02840877 |
Other study ID # |
H-34970 |
Secondary ID |
1R01AI119037-01A |
Status |
Completed |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
May 16, 2017 |
Est. completion date |
October 12, 2023 |
Study information
Verified date |
October 2023 |
Source |
Boston Medical Center |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
After HIV/AIDS, tuberculosis (TB) remains the second leading cause of death due to an
infectious disease globally. Retrospective studies from many countries, including the United
States and South Africa, have consistently reported that in addition to having a higher
burden of TB disease, patients with problem alcohol use have worse TB treatment outcomes.
This prospective study will attempt to clarify both behavioral and biologic causal mechanisms
underlying the deleterious effects of problem alcohol use on TB treatment response.
Description:
A major knowledge gap is the degree to which poor treatment outcomes in alcohol-abusing
patients are due to noncompliance alone. Problem alcohol use impacts on retention in care and
adherence to daily TB treatment. Poor medication adherence and increased default from TB care
have been documented for patients consuming alcohol regularly in several countries. Yet there
has been no research to identify reasons (beyond adherence) for these poorer outcomes among
patients with problem alcohol use. A key barrier to understanding the persistent biologic
effect of alcohol on TB disease is inadequate data on adherence, including detailed data on
daily adherence (or number of missed doses of medication). Research combining better
approaches to alcohol ascertainment and adherence monitoring is needed to advance
understanding of the pathways by which alcohol use and TB disease interact.
Aim 1: To (i) examine the associations between problem alcohol use and TB treatment outcomes,
and (ii) demonstrate that these associations persist independent of adherence to TB
treatment.
Aim 2: To evaluate the effect of problem alcohol use on the pharmacokinetics
(PK)/pharmacodynamics (PD) of TB drugs.
Aim 3: We will use existing samples and data and continue to collect samples and data to (A)
evaluate Mtb diversity in host, its dynamics overtime and in a specific set of drug
resistance, drug tolerance, virulence and immune regulator genes, for evidence of directional
and diversifying selection. We will (B) also evaluate how Mtb diversity and genes under
selection associate with time-to culture conversion (three consecutive weeks of negative
growth) and negative treatment outcomes, adherence, HIV, diabetes mellitus (DM), and
substance use. We will (C) leverage MIC and sequence data from TRUST. We will combine these
with a large public Mtb MIC and WGS dataset enriched for high-level antibiotic resistance
generated by studies that include the NIAID funded Harvard TB Centers of Excellence for
Translational Research (CETR). We will train an in silico MIC predictor and probe
interactions between mutations and the Mtb lineage on a genome-wide scale. The current TRUST
investigators, as well as Dr. Maha Farhat, Harvard Medical School will oversee this aim.
Aim 4: A) To compare rates of dysglycemia (both hyperglycemia and hypoglycemia) in people
living with HIV (PLWH) and HIV-uninfected persons receiving TB treatment in order to assess
changes in blood glucose levels from study enrollment by HIV status and how alcohol use
mediates the relationship; and B) to assess the role stress, inflammation and alcohol
consumption play in relation to blood sugar levels in PLWH and HIV-uninfected individuals and
to assess epigenetic modifications at DNA sites known to be involved in TB risk and
neutrophil, monocyte, T and B cell function.
Culture-positive, pulmonary TB patients will be recruited in Worcester, South Africa, and
followed over an 18-month period. Patients will complete an interviewer-administered
questionnaire on their alcohol use and other health-related behaviors, and their recent
alcohol use will be confirmed using a biomarker (phosphatidylethanol). Chest radiographs,
sputum smears and culture, and blood samples will be collected to compare the biology of
treatment response in patients with and without problem alcohol use. During the 6-month
treatment period, smart mobile-phone technology will be used to document daily drug adherence
by trained community workers. Serial measures of alcohol intake and serial sputa isolates
will be collected to assess treatment response and TB drug side effects will be recorded. In
addition, intensive PK/PD studies of isoniazid, rifampin, ethambutol, and pyrazinamide will
be performed in 200 HIV-seronegative patients. The full cohort will be followed for 12 months
post-treatment to examine long-term TB outcomes, including relapse and death.