Anna Cristina Calçada Carvalho

Fundação Oswaldo Cruz

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Afrânio Lineu Kritski

Universidade Federal do Rio de Janeiro

Alberto Matteelli

University of Brescia

Tânia Cremonini de Araújo-Jorge

Fundação Oswaldo Cruz

Giovanni Battista Migliori

Istituti Clinici Scientifici Maugeri

Valéria C. Rolla

Fundação Oswaldo Cruz

José Roberto Lapa e Silva

Hospital Universitário Clementino Fraga Filho

Bruno B. Andrade

Fundação Oswaldo Cruz

Marcelo Cordeiro‐Santos

Universidade Federal do Amazonas

María B. Arriaga

Complexo Hospitalar Universitário Professor Edgard Santos

Marina C. Figueiredo

Vanderbilt University Medical Center

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Fundação Oswaldo Cruz

114

Universidade Federal do Rio de Janeiro

University of Brescia

Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia

Charles University

Universidade de São Paulo

Istituti di Ricovero e Cura a Carattere Scientifico

Scunthorpe General Hospital

Instituto Evandro Chagas

University of Groningen

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Clinical standards for the dosing and management of TB drugs

The International Journal of Tuberculosis and Lung Disease (2022)

Jan‐Willem C. Alffenaar Sophie L. Stocker Lina Davies Forsman Anthony J. Garcia‐Prats Scott K. Heysell

BACKGROUND: Optimal drug dosing is important to ensure adequate response to treatment, prevent development of drug resistance and reduce drug toxicity. The aim of these clinical standards is to provide guidance on 'best practice´ for dosing and management of TB drugs.METHODS: A panel of 57 global experts in the fields of microbiology, pharmacology and TB care were identified; 51 participated in a Delphi process. A 5-point Likert scale was used to score draft standards. The final document represents the broad consensus and was approved by all participants.RESULTS: Six clinical standards were defined: Standard 1, defining the most appropriate initial dose for TB treatment; Standard 2, identifying patients who may be at risk of sub-optimal drug exposure; Standard 3, identifying patients at risk of developing drug-related toxicity and how best to manage this risk; Standard 4, identifying patients who can benefit from therapeutic drug monitoring (TDM); Standard 5, highlighting education and counselling that should be provided to people initiating TB treatment; and Standard 6, providing essential education for healthcare professionals. In addition, consensus research priorities were identified.CONCLUSION: This is the first consensus-based Clinical Standards for the dosing and management of TB drugs to guide clinicians and programme managers in planning and implementation of locally appropriate measures for optimal person-centred treatment to improve patient care.

Delphi Method

Therapeutic Drug Monitoring

10.5588/ijtld.22.0188

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Citations (48)

Effects of Selenium treatment on cardiac function in Chagas heart disease: Results from the STCC randomized Trial

EClinicalMedicine (2021)

Marcelo Teixeira de Holanda Mauro Felippe Felix Mediano Alejandro Marcel Hasslocher‐Moreno Beatriz Matheus de Souza Gonzaga Anna Cristina Calçada Carvalho

Subgroup analysis

Chagas Disease

10.1016/j.eclinm.2021.101105

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Citations (16)

Research, Innovation, and National Production of Strategic Inputs for Tuberculosis Elimination in Brazil: Contributions from the REDE-TB

Revista da Sociedade Brasileira de Medicina Tropical (2023)

Ricardo Alexandre Arcêncio Érica Chimara José Roberto Lapa e Silva Júlio Croda Anna Cristina Calçada Carvalho

Knowledge Production

10.1590/0037-8682-0518-2023

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Citations (0)

Reversible Reduction of Nevirapine Plasma Concentrations During Rifampicin Treatment in Patients Coinfected With HIV-1 and Tuberculosis

JAIDS Journal of Acquired Immune Deficiency Syndromes (2009)

Alberto Matteelli Nuccia Saleri P. Villani Victor Bonkoungou Anna Cristina Calçada Carvalho

Nevirapine (NVP) plasma levels are reduced in patients receiving rifampicin (RFM) for tuberculosis (TB) treatment. We determined variations over time of the pharmacokinetic parameters of NVP in patients who receive RFM.HIV-1-infected patients with CD4+ T-lymphocyte count

Nevirapine

Stavudine

Concomitant

Efavirenz

10.1097/qai.0b013e3181b0328f

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Citations (15)

Isoniazid Monoresistance and Antituberculosis Treatment Outcome in Persons With Pulmonary Tuberculosis in Brazil

Open Forum Infectious Diseases (2024)

Mariana Araújo‐Pereira María B. Arriaga Anna Cristina Calçada Carvalho Renata Spener-Gomes Carolina Arana Stanis Schmaltz

The high burden of drug-resistant tuberculosis (TB) is a problem to achieve the goals of the End TB Strategy by 2035. Whether isoniazid monoresistance (Hr) affects anti-TB treatment (ATT) outcomes remains unknown in high-burden countries.

10.1093/ofid/ofad691

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Citations (3)

Pediatric tuberculosis in the metropolitan area of Rio de Janeiro

International Journal of Infectious Diseases (2020)

Anna Cristina Calçada Carvalho Pedro da Silva Martins Claudete Aparecida Araújo Cardoso Ana Lúcia Miceli Terezinha Martire

To evaluate the clinical characteristics, diagnostic approach, and treatment outcomes of tuberculosis (TB) in children living in a high-burden metropolitan area.This was a retrospective study, based on a medical chart review, involving children under 15 years old treated for TB between 2007 and 2016, in four primary health units (PHU) and three reference centers (RC) in five cities of Rio de Janeiro metropolitan area. Factors associated with TB treatment setting, microbiological diagnosis, and treatment outcomes were evaluated.A total of 544 children were enrolled; 71% were treated in PHU, 36% were under 5 years old, and 72% had pulmonary TB (PTB). The HIV prevalence was 10% (31/322). Fifty-three percent had at least one microbiological test for TB, 68% of them (196/287) had TB confirmed. Among 222 children with previous TB contact, information on LTBI was available for 78 (35%), and only 17% (13/78) were treated. Extrapulmonary TB (56% vs 32%), microbiologically confirmed TB (77% vs 60%), and HIV positivity (18.5% vs 4.0%) were significantly more frequent in RC. Treatment in RC (odds ratio (OR) 3.08, 95% confidence interval (CI) 1.74-5.44) and PTB (OR 2.47, 95% CI 1.34-4.56) were independently associated with a microbiological diagnosis of TB. The treatment success rate was 85%. In the logistic regression analysis, HIV-infected children had a 2.5-fold higher risk of an unfavorable outcome (OR 2.53, 95% CI 1.0-6.38; p = 0.05).Opportunities for TB prevention and early TB treatment are missed due to suboptimal close contact screening. Microbiological diagnosis of TB and drug susceptibility testing in children should be made available through more sensitive and accessible tests.

10.1016/j.ijid.2020.06.070

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Citations (7)

Viragem da prova tuberculínica entre profissionais da área de saúde em um hospital universitário, referência para AIDS, no Rio de Janeiro, Brasil

Pulmäo RJ (2002)

Gilvan R. Muzy de Souza Leonardo Furukawa Renata Cravo Anna Cristina Calçada Carvalho Marcus Barreto Conde

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Citations (7)

Determinants of losses in the tuberculosis infection cascade of care among children and adolescent contacts of pulmonary tuberculosis cases: A Brazilian multi-centre longitudinal study

The Lancet Regional Health - Americas (2022)

Luciana Fonseca Sobral María B. Arriaga Alexandra B. Souza Mariana Araújo‐Pereira Beatriz Barreto‐Duarte

Approximately 10% of the global tuberculosis (TB) burden is in children. Identification, diagnosis, and early treatment of Mycobacterium tuberculosis infection (TBI) is critical to prevent progression to TB in children. The risk of TB, including severe disease, is highest in children <5 years old. We evaluated the cascade of TBI care among child and adolescent TB contacts to identify factors associated with losses in the cascade.Close contacts ≤ 18 years old of pulmonary TB patients enrolled between 2015 and 2019 in a multi-centre Brazilian cohort were followed for up to 24 months and classified according to age groups: <5 years, 5-9 years, 10-14 years and 15-18 years. Data on clinical investigation, radiographic examination, IGRA testing at baseline and 6 months, initiation and completion of TB preventive treatment (TPT) were collected. Multivariable regression analyses identified factors associated with TBI and losses in the cascade of care in children and adolescents.Among 1795 TB contacts initially identified, 530 (29·5%) were ≤18 years old. Losses for all steps in the cascade were especially high in children <5 years old (88%) because at this age all contacts are recommended to initiate TPT. As a proportion of all children, completion of TPT was low (between 10% and 13%) in all age-groups. Furthermore, multivariable regression revealed that younger age of contacts and TB index cases who were female, had pulmonary cavities, and persistent cough were independently associated with losses in the cascade of care among persons ≤18 years old.Losses in the TBI cascade were the highest among children <5 years, which was the group at highest risk for TB among the four age groups. The findings highlight the need to improve screening, initiation, and completion of TPT of young children who are close contacts of people with TB in Brazil.National Institutes of Allergy and Infectious Diseases.

Longitudinal Study

10.1016/j.lana.2022.100358

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Citations (5)

Delayed Diagnosis of Disseminated Mycobacterium genavense Infection in a Human Immunodeficiency Virus-Negative Young Woman

Infectious Diseases in Clinical Practice (2010)

Enrico Tortoli Roberta Mannino Anna Cristina Calçada Carvalho Alberto Matteelli

We report here a case of Mycobacterium genavense-disseminated infection in a human immunodeficiency virus-negative young patient under immunosuppressive treatment for autoimmune chronic hepatitis type I. The diagnosis was achieved thanks to the detection of Mycobacterium genavense-specific DNA in a hepatic biopsy embedded in paraffin for histologic examination 2 years before.

10.1097/ipc.0b013e3181fc6e92

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Citations (0)

The role of the Brazilian Tuberculosis Research Network in national and international efforts to eliminate tuberculosis

Jornal Brasileiro de Pneumologia (2018)

Afrânio Lineu Kritski Margareth Pretti Dalcolmo Fernanda Carvalho de Queiroz Mello Anna Cristina Calçada Carvalho Denise Rossato Silva

In 2015, tuberculosis ranked as the leading cause of death from an infectious disease, surpassing HIV/AIDS.(1) In 2016, an estimated 10.4 million people developed tuberculosis and 1.7 million died from the disease, 5,000 people dying from it every day, including approximately 1,000 individuals with tuberculosis/HIV coinfection.(1) In the past decade, the global tuberculosis community has engaged in activities to successfully attain the Millennium Development Goal target and other international targets for halting and reversing increases in tuberculosis incidence and mortality.(1) However, despite the achievements made to date, the global incidence of tuberculosis is declining at a rate of only 1.5% per year, far from the 10% expected.

History of tuberculosis

10.1590/s1806-37562017000000435

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Citations (19)