Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Prednisolone ineffective against HIV-associated pleural tuberculosis

06.08.2004


Nor can it be recommended for those with pleural tuberculosis who are not co-infected with HIV

Prednisolone, a glucocorticoid that is sometimes added to anti-tuberculosis drug regimens, should not be used to treat patients with pleural tuberculosis and HIV infection, nor can it be recommended for those with pleural tuberculosis who are not co-infected with HIV, according to a study in the August 15 issue of The Journal of Infectious Diseases, now available online.

Alison M. Elliott, of the London School of Hygiene and Tropical Medicine, and colleagues from Uganda, England, and the United States conducted a double-blind, placebo-controlled study of prednisolone in 197 patients with HIV-1-associated pleural tuberculosis. The expectation was that the drug might retard HIV progression and thus prolong survival. In fact, it had no effect on survival but did increase the risk of the AIDS-related cancer Kaposi’s sarcoma.



The investigators noted that, although prednisolone suppresses the immune system’s response to tuberculosis when used alone, its use is associated with improved survival when taken with anti-tuberculosis drugs--notably, in pericardial tuberculosis. Previous studies had shown that active tuberculosis is associated with a high degree of immune activation, which also plays a large role in promoting HIV replication. The investigators therefore hypothesized that adding prednisolone to a regimen of anti-tuberculosis drugs might inhibit viral replication, retard progression of HIV disease, and improve long-term survival. As prednisolone is relatively inexpensive and widely available, this would have been of value in fighting tuberculosis and HIV co-infection, especially in resource-poor regions of the world as sub-Saharan Africa.

The authors performed their study at the National Tuberculosis Treatment Centre in Kampala, Uganda between November 1998 and January 2002. Of the 197 patients studied, 99 were given prednisolone and 98 a placebo, along with standard tuberculosis treatment.

The patients receiving prednisolone did see improvement in the principal signs and symptoms of pleural tuberculosis, especially anorexia, weight loss, and cough. Although prednisolone use was not associated with such HIV-associated opportunistic diseases as cryptococcal meningitis, esophageal or oral candidiasis, herpes zoster, or oral or genital herpes simplex infection, it did significantly increase the risk of Kaposi’s sarcoma, six cases of which were observed, and only in the prednisolone group. This finding mirrored a previous Zambian study in which Kaposi’s sarcoma also occurred only in a group given prednisolone to treat pleural tuberculosis. An opportunistic disease associated with human herpes virus 8 infection, Kaposi’s sarcoma is often difficult to treat and may be fatal.

Given an increased risk of Kaposi’s sarcoma, no improvement in survival, and no reported long-term benefits of glucocorticoids in patients with pleural tuberculosis who were not HIV-infected, the authors concluded that pleural tuberculosis should not be treated with prednisolone, regardless of HIV status. This recommendation, they noted, does not extend to other uses of prednisolone, such as treatment of pericardial tuberculosis or Pneumocystis carinii pneumonia, for which the drug can prolong or save lives, regardless of a patient’s HIV status. They warned, however, that "prednisolone should be used with caution in situations where no beneficial effect on immediate survival can be expected."

Jeff Minerd | EurekAlert!
Further information:
http://www.idsociety.org

More articles from Health and Medicine:

nachricht A promising target for kidney fibrosis
21.04.2017 | Brigham and Women's Hospital

nachricht Stem cell transplants: activating signal paths may protect from graft-versus-host disease
20.04.2017 | Technische Universität München

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

7th International Conference on Crystalline Silicon Photovoltaics in Freiburg on April 3-5, 2017

03.04.2017 | Event News

 
Latest News

NASA's Fermi catches gamma-ray flashes from tropical storms

25.04.2017 | Physics and Astronomy

Researchers invent process to make sustainable rubber, plastics

25.04.2017 | Materials Sciences

Transfecting cells gently – the LZH presents a GNOME prototype at the Labvolution 2017

25.04.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>