TB/HIV meeting held in conjunction with the 14th conference on retroviruses and opportunistic infections
The Global TB/HIV Working Group of the Stop TB Partnership in collaboration with the Consortium to Respond Effectively to the AIDS TB Epidemic (CREATE) has organized a TB/HIV meeting in conjunction with the 14th Conference on retroviruses and opportunistic infections in Los Angeles, USA. About 40 leading researchers in the field attended the meeting and was co-chaired by Dr D. Havlir, chairperson of the Global TB/HIV Working Group and Dr S. Lehrman Director, Therapeutics Research Program, Division of AIDS, NIH, USA. The main objective of this meeting was to familiarise selected participants of the Conference with the functions of the Global TB/HIV Working Group (WG) of the Stop TB Partnership and to share and discuss key TB/HIV research issues and ongoing efforts. The meeting raised the awareness about the Global TB/HIV WG and a one pager brief about the WG was distributed. Presentations were done and discussions conducted about the ongoing research efforts and priorities around key areas (see presentations below). The importance of TB prevention in people living with HIV has been emphasized and research priorities including screening algorithms to rule out TB and best tools to diagnose latent TB were discussed. The possibility of developing a single prophylaxis tablet for people living with HIV for the commonest opportunistic illnesses, including TB was raised during the discussion. The research priorities and ongoing efforts about ART for TB patients were presented. However, it was appalling to learn that most of the reported studies that intended to study ART delivery among TB patients were either stopped or crinkling, which was worrisome particularly in the face of the multiple unanswered questions of ART delivery in TB patients. The case definition of Immune reconsistition syndrome (IRIS) in TB patients, which was the outcome of an earlier meeting that was held in Uganda, Kampala has been presented. The following major and minor criteria were presented. Major criteria include: (1)New/enlarging lymph nodes, cold abscesses or other focal tissue involvement; (2) New/worsening radiological features of TB; (3)Breakthrough TB meningitis or new/enlarging focal CNS lesion; (4)New or Worsening serositis. Minor criteria include: (1)Constitutional symptoms- e.g., fever, night sweats;(2) Respiratory symptoms - e.g., cough, dyspnea, stridor;(3) Abdominal pain and/or hepatomegaly;(4) Resolution of clinical and/or radiological findings without change in TB treatment. A patient is classified as TB IRIS if has one major or 2 minor criteria. The urgent research priorities to accelerate the implementation of the new global recommendations to expedite the diagnosis and management of TB in HIV prevalent and resource constrained settings and the research priority implications of extensively resistant TB(XDR TB) were presented. There was high level of interest from the participants on all topics and it was agreed that a follow-up meeting in conjunction with the upcoming IAS 2007 Conference in Sydney will be useful. It was suggested that the WG should find a systematic way of registering and following up ongoing clinical trials of ART in TB patients in a more updated way through constant and close consultation with partners such as the NIH. It needs to develop a targeted research advocacy agenda and monitor the implementation of the research priority questions identified in 2005.