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Impact of HIV Infection on Latent Tuberculosis (TB) Among Patients With HIV-TB Co-infection

The recruitment status of this study is unknown because the information has not been verified recently.
Verified June 2008 by Ministry of Science and Technology, India.
Recruitment status was  Recruiting
Sponsor:
Collaborator:
Indian Council of Medical Research
Information provided by:
Ministry of Science and Technology, India
ClinicalTrials.gov Identifier:
NCT00692809
First received: June 5, 2008
Last updated: September 14, 2009
Last verified: June 2008
History of Changes
  Purpose

HIV induced altered representation and function of regulatory T cell subsets (NKT and Treg cells) impair the protective T cell response against M.tuberculosis and disrupts LTBI, thus facilitates faster progression and development of severe forms of clinical TB in HIV-TB co-infection.


Condition
Latent Tuberculosis Infection
HIV Infections
Tuberculosis

Study Type: Observational
Study Design: Time Perspective: Prospective
Official Title: Impact of HIV Infection on Latent TB Among Patients With HIV-TB Co-infection

Resource links provided by NLM:

U.S. FDA Resources

Further study details as provided by Ministry of Science and Technology, India:

Primary Outcome Measures:
  • Precise component(s) of T cell response against M.tuberculosis compromised by HIV infection which leads to the development of severe forms of clinical tuberculosis. [ Time Frame: 5 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Elucidation of critical events of the cellular and molecular interactions that would be useful for developing newer therapeutic strategies and vaccination. [ Time Frame: 5 months ] [ Designated as safety issue: No ]

Estimated Enrollment: 180
Study Start Date: July 2008
Estimated Study Completion Date: March 2010
Estimated Primary Completion Date: March 2010 (Final data collection date for primary outcome measure)
Groups/Cohorts
1
HIV+ve+LTBI (n=100)
2
HIV+ve+clinical TB (n=50)
3
HIV-ve+clinical TB (n=15)
4
Normal control (n=15)

Detailed Description:

During the natural course of HIV disease, emergence of opportunistic infection not only imposes morbidity on HIV-TB co-infected patients, but also facilitates viral replication causing faster disease progression. Tuberculosis, being the commonest among the opportunistic infections among HIV infected persons deserves special attention. Moreover, disruption of latency of TB infection (LTBI) with development of more severe clinical forms at relatively early stage of HIV disease when CD4 count still remains above 300/ul, makes TB a unique opportunistic infection and negatively influence the outcome of dual infection.This is suggestive of impairment of some critical immune function involving relatively less frequent fine T cell subsets with functional hierarchy over bulk T cells, so as to weaken the immune containment of LTBI resulting in reactivation of M. tuberculosis and manifestation of severe forms of TB.HIV has recently been reported to preferentially infect, destroy and incapacitate two key immune-regulatory T cell subsets, namely NKT and Treg cells.Therefore, studying them along the course of HIV disease and impact of their changes on the function of effector T cells directed against M.tuberculosis is important.

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population

HIV+ve+LTBI HIV+ve+clinical TB HIV-ve+clinical TB Normal control

Criteria

Inclusion Criteria:

HIV infected +LTBI group:

  • Patient of either sex between 18-65 years of age
  • All the patients should be HIV ELISA test positive irrespective of CD4 count and presence of other opportunistic infections Antiretroviral drug naive HIV patients
  • No past history of TB
  • Patients should be either tuberculin test positive (> 5mm) or interferon gamma release assay positive
  • Written informed consent to participate in the study given by participants or legal guardian
  • Patients able to comply with instructions and come back for a regular follow up

HIV infected + Clinical TB group:

  • Patient of either sex between 18-65 years of age
  • All the patients should be HIV ELISA test positive irrespective of CD4 count and presence of other opportunistic infections
  • In PTB group, patient should be two sputum smear positive out of three consecutive samples

  • In EPTB group, diagnosis of TB will be:

    • Definitive -Culture confirmed
    • Probable -Histopathological or radiological -Clinical features and response to anti TB treatment (ATT)
    • Possible TB -Clinical feature and response to anti TB treatment (ATT)
  • Written informed consent to participate in the study given by participants or legal guardian
  • Patients able to comply with instructions and come back for a regular follow up

HIV negative Clinical TB group:

  • Patients of either sex between 18-65 years of age who are permanent resident of Delhi
  • All patients should be HIV ELISA negative
  • In PTB group, patients should be two sputum smear positive (at least 1+) out of three consecutive samples

  • In EPTB group, diagnosis of TB will be:

    • Definitive -Culture-confirmed
    • Probable -Histopathological or radiological -Clinical features and response to anti-TB treatment (ATT)
    • Possible TB -Clinical features and response to anti-TB treatment (ATT)
  • Written informed consent to participate in the study given by participants or legal guardian
  • Patients able to comply with instructions and come back for a regular follow up

Normal controls:

  • Persons of either sex between 18-65 years of age who are permanent resident of Delhi
  • Written informed consent to participate in the study given by participants or legal guardian

  • Person should not have past history of TB

    • Mantoux test negative (< 10mm)
    • Chest-X-ray normal
    • Hemogram normal
  • Renal and liver functions normal
  • Hepatitis viral markers normal
  • No clinical evidence of malnutrition
  • HIV ELISA negative

Exclusion Criteria:

HIV infected +LTBI group:

  • Pregnant and lactating females
  • Patients who are getting steroid therapy
  • Transplant patients, diabetes mellitus or malignancy, chronic renal failure or liver diseases
  • Currently receiving cytotoxic therapy, or have received it within the last 3 months
  • Terminally ill as per treating clinician's judgment
  • Patient from outside Delhi and migrants

HIV infected + Clinical TB group:

  • Category II and multidrug-resistant pulmonary tuberculosis
  • Pregnant and lactating females
  • Patients who are getting steroid therapy
  • Transplant patients, diabetes mellitus or malignancy, chronic renal failure or liver diseases
  • Currently receiving cytotoxic therapy, or have received it within the last 3 months
  • Terminally ill patient as per treating clinician's judgment
  • Patients from outside Delhi and migrants

HIV negative Clinical TB group:

  • Category II and multi drug-resistant pulmonary tuberculosis
  • Patients who are getting steroid therapy
  • Transplant patients, diabetes mellitus or malignancy, chronic renal failure or liver disease
  • Currently receiving cytotoxic therapy, or have received it within the last 3 months
  • Terminally ill patient as per treating clinician's judgment
  • Patients unwilling to comply with the study procedures or those with history of alcohol or drug abuse

Normal controls:

  • Transplant patients, diabetes mellitus or malignancy
  • Patients unwilling to comply with the study procedures or those with history of alcohol or drug abuse
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00692809

Contacts
Contact: Surendra K Sharma, M.D., Ph.D 26594415 surensk@gmail.com

Locations
India
All India Institute of Medical Sciences Recruiting
New Delhi, Delhi, India, 110608
Contact: Surendra K Sharma, M.D., Ph.D     26594415     surensk@gmail.com    
Contact: Sanjeev Sinha, MD     26594440     drsanjeevsinha2002@yahoo.com    
Principal Investigator: Surendra K Sharma, M.D., Ph.D            
Sub-Investigator: Sanjeev Sinha, MD            
Principal Investigator: Dipender K Mitra, Ph.D            
Sub-Investigator: Amit K Dinda, MD            
Sponsors and Collaborators
Ministry of Science and Technology, India
Indian Council of Medical Research
Investigators
Principal Investigator: Surendra K Sharma, M.D., Ph.D All India Institute of Medical Sciences, New Delhi
  More Information

No publications provided

Responsible Party: Dr. S.K. Sharma, Professor & Head, All India Institute of Medical Sciences
ClinicalTrials.gov Identifier: NCT00692809     History of Changes
Other Study ID Numbers: SKS/LTBI/07
Study First Received: June 5, 2008
Last Updated: September 14, 2009
Health Authority: India: Institutional Review Board

Keywords provided by Ministry of Science and Technology, India:
Latent tuberculosis infection
Human immunodeficiency virus
Tuberculosis
Natural Killer T Cells
 Invariant Natural Killer T Cells
Regulatory T cells
Interferon-gamma

Additional relevant MeSH terms:
HIV Infections
Acquired Immunodeficiency Syndrome
Tuberculosis
Latent Tuberculosis
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
 Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Slow Virus Diseases
Mycobacterium Infections
Actinomycetales Infections
Gram-Positive Bacterial Infections
Bacterial Infections

ClinicalTrials.gov processed this record on March 03, 2013