A5025636681- Tuberculosis Research and Epidemiology
- Pneumocystis jirovecii pneumonia detection and treatment
- Mycobacterium research and diagnosis
- Pneumonia and Respiratory Infections
- Diagnosis and treatment of tuberculosis
- HIV/AIDS drug development and treatment
- HIV/AIDS Research and Interventions
- Infectious Diseases and Tuberculosis
- Hematological disorders and diagnostics
- HIV-related health complications and treatments
- HIV Research and Treatment
- Biosimilars and Bioanalytical Methods
- Cancer Treatment and Pharmacology
- Polyomavirus and related diseases
- HIV/AIDS Impact and Responses
- Adolescent Sexual and Reproductive Health
- Brain Metastases and Treatment
- Clinical Reasoning and Diagnostic Skills
- Digital Imaging for Blood Diseases
- Religion, Society, and Development
- COVID-19 diagnosis using AI
- Respiratory Support and Mechanisms
- Cytomegalovirus and herpesvirus research
- Organizational Strategy and Culture
- RNA and protein synthesis mechanisms
University of California, San Francisco
2015-2025
San Francisco General Hospital
2012-2025
Makerere University
2023-2024
University of California System
2013-2023
Infectious Diseases Research Collaboration
2017
Pulmonary and Critical Care Associates
2013
Rationale The clinical impact of Xpert MTB/RIF for tuberculosis (TB) diagnosis in high HIV-prevalence settings is unknown. Objective To determine the diagnostic accuracy and among high-risk TB suspects. Methods We prospectively enrolled consecutive, hospitalized, Ugandan suspects two phases: baseline phase which results were not reported to clinicians an implementation reported. determined reference culture (solid liquid) compared patient outcomes by study phase. Results 477 patients...
Tuberculosis, a major cause of death in people living with HIV, remains challenging to diagnose. Diagnostic accuracy data are scarce for promising triage and confirmatory tests such as C-reactive protein (CRP), sputum urine Xpert MTB/RIF Ultra (Xpert Ultra), Determine TB LAM Ag (a lateral flow lipoarabinomannan [LF-LAM] test), without symptom selection. We evaluated novel ambulatory HIV initiating antiretroviral therapy (ART).
ABSTRACT Blood transcriptional signatures are promising for tuberculosis (TB) diagnosis but have not been evaluated among U.S. patients. To be used clinically, classifiers need reproducible accuracy in diverse populations that vary genetic composition, disease spectrum and severity, comorbidities. In a prospective case-control study, we identified novel active TB patients systematically compared their to from published studies. samples HIV-uninfected adults with TB, pneumonia, or latent...
Abstract Approximately 3.6 million cases of active tuberculosis (TB) go potentially undiagnosed annually, partly due to limited access confirmatory diagnostic tests, such as molecular assays or mycobacterial culture, in community and primary healthcare settings. This article provides guidance for TB triage test evaluations. A is designed use people with symptoms and/or significant risk factors TB. Triage tests are simple low-cost aiming improve ease implementation (compared tests) decrease...
The recommended tuberculosis (TB) intensified case finding (ICF) algorithm for people living with HIV (symptom-based screening followed by Xpert MTB/RIF [Xpert] testing) is insufficiently sensitive and results in unnecessary testing.To evaluate whether novel ICF algorithms combining C-reactive protein (CRP)-based urine Determine TB-LAM (TB-LAM), sputum Xpert, and/or culture could improve yield efficiency.We compared the efficiency of inclusive point-of-care CRP-based TB confirmatory testing...
Abstract Background Systematic tuberculosis (TB) screening is recommended for all people with HIV (PWH) because of its potential to improve TB outcomes through earlier diagnosis and treatment initiation. As such, systematic may be particularly important men, who experience excess prevalence mortality compared women. We assessed sex differences among PWH undergoing screening, including severity, diagnostic accuracy tools, outcomes. Methods enrolled followed adults (CD4 ≤ 350 cells/µL)...
Symptom-based tuberculosis screening identifies less than one-third of eligible HIV-infected patients as candidates for isoniazid preventive therapy (IPT). We evaluated whether testing C-reactive protein (CRP) improves patient selection IPT.We measured CRP levels (normal <10 mg/L) using a point-of-care (POC) assay on stored serum samples from Ugandan adults initiating antiretroviral therapy. assessed diagnostic accuracy in reference to baseline status adjudicated by an expert committee and...
Gene-expression profiles have been reported to distinguish between patients with and without active tuberculosis (TB), but no prior study has conducted in the context of TB screening. We included all (n = 40) culture-confirmed time-matched controls 80) enrolled July 2013 April 2015 a screening among people living human immunodeficiency virus (PLHIV) Kampala, Uganda. randomly split into training test datasets. used dataset derive candidate signatures that consisted 1 5...
Pneumocystis jirovecii dihydropteroate synthase (DHPS) gene mutations are well-reported. Although sulfa prophylaxis generally is associated with DHPS mutant infection, whether infection poorer clinical outcomes less clear. The differing definitions of and the different mortality endpoints used in these studies may be one explanation for conflicting study results. Applying prophylaxis, to 301 HIV-infected patients pneumonia, we demonstrate that irrespective definition, increased risk pure...
The objective of this prospective cross-sectional study, conducted at a national referral hospital in Kampala, Uganda, was to determine diagnostic performance serum C-reactive protein (CRP) as triage test for tuberculosis (TB) among HIV-seronegative inpatients. We calculated the sensitivity, specificity, positive and negative likelihood ratios, predictive values CRP enzyme-linked immunosorbent assay (ELISA) (Eurolyser) comparison that reference standard Mycobacterium culture on two sputum...
C-reactive protein (CRP) has shown promise as a triage tool for pulmonary tuberculosis (TB) in adults living with the human immunodeficiency virus. We performed first assessment of CRP TB children. Symptomatic children less than 15 years old were prospectively enrolled Kampala, Uganda. completed standard evaluation and measured using point-of-care assay. determined sensitivity specificity to identify 10 mg/L 5 cut-off points generated receiver operating characteristic (ROC) curve determine...
Approaches to screening for active tuberculosis (TB) among people living with HIV are inadequate, leading missed diagnoses and poor implementation of preventive therapy.Consecutive HIV-infected adults hospitalized at Mulago Hospital (Kampala, Uganda) between June 2011 July 2013 a cough ≥ 2 weeks were enrolled. Patients underwent extensive evaluation pulmonary TB. Concentrations 43 cytokines/chemokines measured the same time point as C-reactive protein (CRP) in banked plasma samples using...
Better triage tests for screening tuberculosis (TB) disease are needed people living with HIV (PLHIV). We performed the first evaluation of a previously-validated 8-antigen serological panel to screen PLHIV pulmonary TB in Kampala, Uganda. selected random 1:1 sample and without (defined by sputum culture) from cohort initiating antiretroviral therapy. used multiplex microbead immunoassay an ensemble machine learning classifier determine area under receiver operating characteristic curve...
In resource-limited settings, mortality in the initial months following antiretroviral therapy (ART) initiation remains unacceptably high. Novel tools to identify patients at highest risk of poor outcomes are needed. We evaluated whether elevated C-reactive protein (CRP) concentrations predict among people living with HIV (PLWH) initiating ART.We enrolled and followed for 3-months consecutive PLWH pre-ART CD4 T-cell counts 350 cells/μl or less ART from two clinics Uganda. Pre-ART CRP were...
C-reactive protein (CRP)-based tuberculosis (TB) screening is recommended for people with HIV (PWH). However, its performance among without and in diverse settings unknown.
Abstract Background Following early implementation of public health measures, San Francisco has experienced a slow rise and low peak level coronavirus disease 2019 (COVID-19) cases deaths. Methods Findings We included all patients with COVID-19 pneumonia admitted to the intensive care unit (ICU) at safety net hospital for through April 8, 2020. Each patient had ≥15 days follow-up. Among 26 patients, median age was 54 years (interquartile range, 43 62), 65% were men, 77% Latinx. Mechanical...
Abstract Background People living with HIV (PLHIV) have an increased risk of developing active tuberculosis (TB). To reduce the burden TB among PLHIV, World Health Organization (WHO) recommends systematic screening followed by (1) confirmatory testing for all who screen positive and (2) preventive therapy (TPT) TPT-eligible PLHIV negative. Symptom-based remains standard care in most high settings, including Uganda. Despite having sensitivity antiretroviral-naïve symptom has poor specificity;...