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ma=86400 Characterization of progressive HIV-associated tuberculosis using 2-deoxy-2-[18F]fluoro-D-glucose positron emission and computed tomography | Nature Medicine
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Characterization of progressive HIV-associated tuberculosis using 2-deoxy-2-[18F]fluoro-D-glucose positron emission and computed tomography

Nature Medicine volume 22, pages 1090–1093 (2016)Cite this article

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Abstract

Tuberculosis is classically divided into states of latent infection and active disease. Using combined positron emission and computed tomography in 35 asymptomatic, antiretroviral-therapy-naive, HIV-1-infected adults with latent tuberculosis, we identified ten individuals with pulmonary abnormalities suggestive of subclinical, active disease who were substantially more likely to progress to clinical disease. Our findings challenge the conventional two-state paradigm and may aid future identification of biomarkers that are predictive of progression.

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Figure 1: Radiological and clinical findings in participants with evidence of subclinical pathology (infiltrates, scars or active nodules).
Figure 2: Radiological findings in participants with discrete nodules.

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Acknowledgements

This work was funded by the Wellcome Trust (grant no. 090170 (H.E.) and 104803 (R.J.W.)), the Bill and Melinda Gates Foundation–Wellcome Trust Grand challenges in Global Health (grant no. 37822; D.B.Y.), the US National Institutes of Health (NIH) (grant no. R01 HL106804; J.L.F.) and the intramural research program of the NIH–NIAID (C.E.B.). R.J.W. also received support from the European Union (grant no. FP& HEALTH F3-2012-305578), the National Research Foundation of South Africa (grant no. 96841), the Research Councils of the UK via the Francis Crick Institute (grant no. 10218 and U117565642) and the Medical Research Council of South Africa (Strategic Health Innovations partnership).

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Authors and Affiliations

  1. Department of Medicine, Imperial College London, London, UK

    Hanif Esmail, Douglas B Young & Robert J Wilkinson

  2. Clinical Infectious Disease Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa

    Hanif Esmail, Maia Lesosky, Katalin A Wilkinson, Anna K Coussens, Tolu Oni, Clifton E Barry III & Robert J Wilkinson

  3. Radcliffe Department of Medicine, University of Oxford, Oxford, UK

    Hanif Esmail

  4. Francis Crick Institute Mill Hill Laboratory, London, UK

    Rachel P Lai, Katalin A Wilkinson, Christine M Graham, Douglas B Young, Anne O'Garra & Robert J Wilkinson

  5. Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

    Maia Lesosky

  6. Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa

    James M Warwick

  7. Department of Radiology, Groote Schuur Hospital, Cape Town, South Africa

    Qonita Said-Hartley

  8. Department of Medicine, Stellenbosch University, Cape Town, South Africa

    Coenraad F Koegelenberg & Gerhard Walzl

  9. Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

    Gerhard Walzl & Clifton E Barry III

  10. Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    JoAnne L Flynn

  11. Tuberculosis Research Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA

    Clifton E Barry III

  12. Department of Pathology, University of Cape Town, Cape Town, South Africa

    Clifton E Barry III

  13. National Heart and Lung Institute, Imperial College London, London, UK

    Anne O'Garra

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  1. Hanif Esmail
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  2. Rachel P Lai
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Contributions

H.E., A.O., C.E.B. and R.J.W. designed the study with input from K.A.W., D.B.Y. and J.L.F.; H.E., T.O. and Q.S.-H. screened participants for study entry; H.E., G.W. and C.F.K. collected samples and data, and provided clinical care for participants during follow-up; J.M.W. led the radiologists and nuclear medicine physicians who reported the [18F]FDG PET–CT scans; K.A.W. and H.E. processed samples; H.E., M.L. and R.P.L. analyzed data with advice and input from R.J.W., K.A.W., C.E.B., J.M.W., A.K.C., C.M.G., A.O. and J.L.F.; R.J.W. supervised data analysis; H.E. and R.J.W. wrote the manuscript, with early input from A.O., C.E.B., D.B.Y., M.L. and J.L.F., and subsequently all authors provided advice and approved the final manuscript.

Corresponding authors

Correspondence to Hanif Esmail or Robert J Wilkinson.

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The authors declare no competing financial interests.

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Supplementary Figures 1–3 and Supplementary Table 1 (PDF 1878 kb)

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Esmail, H., Lai, R., Lesosky, M. et al. Characterization of progressive HIV-associated tuberculosis using 2-deoxy-2-[18F]fluoro-D-glucose positron emission and computed tomography. Nat Med 22, 1090–1093 (2016). https://doi.org/10.1038/nm.4161

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