Factors Affecting Continued Participation in Tuberculosis Contact Investigation in a Low-Income, High-Burden Setting.

SETTING: Outpatient clinics, Kota Kinabalu, Malaysia; January-April 2018. OBJECTIVES: To identify barriers to full participation in tuberculosis (TB) contact investigation. METHODS: Cross-sectional study of knowledge, perceptions, and behaviours among TB contacts. This study was conducted among contacts who attended an initial clinic visit to explore retention in care. During this first visit, contacts were approached for participation in a questionnaire at a follow-up visit. Contacts who consented but did not subsequently attend were interviewed at home. Associations between questionnaire findings and attendance were tested using logistic regression. RESULTS: Of the total 1436 identified contacts, 800 (56%) attended an initial clinic visit. Of 237 consenting TB contacts, 207 (87%) attended their follow-up appointment. In univariable analyses, the odds of attendance were highest for people notified to attend the TB clinic directly by a health inspector; close relatives of TB patients; non-students; people with higher incomes and smaller households; older individuals; males; and people not perceiving TB as stigmatising. In multivariable analysis, mode of notification to attend and having a close relative with TB remained significant. CONCLUSIONS: Health inspectors provide an effective role in TB contact investigation through direct personal communication to encourage the completion of the TB screening process, but this requires further integration with clinical processes, and with workplace and school-based investigations.

Whole genome sequencing data and analysis of a rifampicin-resistant Mycobacterium tuberculosis strain SBH162 from Sabah, Malaysia.

A Mycobacterium tuberculosis strain SBH162 was isolated from a 49-year-old male with pulmonary tuberculosis. GeneXpert MDR/RIF identified the strain as rifampicin-resistant M. tuberculosis. The whole genome sequencing was performed using Illumina HiSeq 4000 system to further investigate and verify the mutation sites of the strain through genetic analyses namely variant calling using bioinformatics tools. The de novo assembly of genome generated 100 contigs with N50 of 156,381bp. The whole genome size was 4,343,911 bp with G + C content of 65.58% and consisted of 4,306 predicted genes. The mutation site, S450L, for rifampicin resistance was detected in the rpoB gene. Based on the phylogenetic analysis using the Maximum Likelihood method, the strain was identified as belonging to the Europe America Africa lineage (Lineage 4). The genome dataset has been deposited at DDBJ/ENA/GenBank under the accession number SMOE00000000.

Validation of three-dimensional laser scanning for the assessment of facial fat changes.

OBJECTIVE: We aimed to evaluate the accuracy of three-dimensional laser scanning as an objective method for detecting facial changes. METHODS: Facial laser scanning was performed at baseline and repeated after a median of 10 months in 24 HIV-infected patients, 12 with ongoing lipodystrophy, five with >10% weight loss and seven with >10% weight gain. Surface volume change was estimated using a standardized technique, and compared with change in cheek fat measured by magnetic resonance imaging (MRI). RESULTS: The median laser scanning surface volume changes were -2.1 (range -4.6 to -0.8) mL in the lipoatrophy group, -1.5 (range -6.8 to -1.3) mL in the weight loss group and +3.1 (range -0.2 to +5.4) mL in the weight gain group (the median MRI cheek fat changes were -4.6, -3.7 and +7.0 mL in the three groups, respectively). Laser scanning and MRI measurements were not significantly associated in lipoatrophy patients (r=0.34, P=0.28), but there was a good association in patients who changed weight (r=0.71, P=0.01). CONCLUSIONS: Laser scanning detects changes in the appropriate direction, although it underestimates MRI-measured cheek fat changes. Laser scanning may be useful as an objective measure of cheek surface volume changes, but needs further validation in larger clinical cohorts.

Changes in facial fat in HIV-related lipoatrophy, wasting, and weight gain measured by magnetic resonance imaging.

BACKGROUND: Changes in facial fat occurring over time in patients with HIV-related lipoatrophy have not been properly quantified. We aimed to define the longitudinal changes in facial fat compartments in patients with lipoatrophy and to compare these with changes accompanying wasting or weight gain. METHOD: Facial MRI scans were performed at baseline and repeated after a median of 10 months in 24 patients, of whom 12 had moderate to severe lipodystrophy continuing antiretroviral therapy, 5 lost weight, and 7 gained weight (more than 10% weight change). RESULTS: Superficial facial fat decreased by a median of 5.2 mL (p = .03) in patients with lipoatrophy, and 8 of 12 individuals showed more than 15% decrease (all of whom were taking stavudine). The decrease was mainly cheek fat. Superficial facial fat decreased by 6.0 mL in patients with weight loss (p = .04) and increased by 20.2 mL (p = .02) in patients with weight gain, and changes occurred in cheek fat, temporal fat, and masseter muscle and temporalis muscle compartments. CONCLUSION: MRI can detect substantial ongoing changes in facial fat in patients with facial lipoatrophy. A characteristic pattern of compartmental change distinguishes lipoatrophy from wasting and weight recovery. MRI should be considered for use in clinical trials of interventions to prevent or treat lipoatrophy and may be useful for documenting changes in individual patients during clinical follow-up.

Changes in body fat measured by DEXA in patients taking different formulations of stavudine.

BACKGROUND: Lipoatrophy is a frequent complication of chronic stavudine therapy. Stavudine extended release formulation (stavudine ER) gives lower peak and higher trough levels than the immediate release formulation (stavudine IR), and we hypothesized that the lower peak might result in less lipoatrophy. OBJECTIVE: To compare the rate of peripheral lipoatrophy between patients taking stavudine ER and stavudine IR. METHOD: Body composition was measured by dual energy X-ray absorptiometry (DEXA) every 6 months for 18 months in 29 patients taking either stavudine ER or IR as part of a randomized controlled clinical trial. RESULTS: DEXA fat measurements did not differ between the ER and IR groups at baseline, after a median of 32 months on stavudine-containing treatment. Over the 18 months of follow-up in the whole cohort limb fat decreased by a mean of 0.29 +/- 0.50 kg (p = .01) and leg fat percent decreased by a mean of 1.23% +/- 1.92% (p = .001), whereas trunk fat and trunk-to-limb fat percent ratio did not change significantly. There was no significant difference between the ER and IR groups in the rate of change of any of the fat parameters. At study completion, the proportion of patients with clinical lipodystrophy was similar in the stavudine ER and stavudine IR groups (67% and 64%, respectively; p = .893). CONCLUSION: Stavudine ER does not appear to cause less peripheral lipoatrophy.