Clinical effects of sirolimus treatment in patients with increased serum creatinine levels after renal transplant

Purpose: To observe the clinical effects of sirolimus (SRL) immunosuppressive therapy in patients with progressively increasing levels of serum creatinine (Scr) after renal transplant. Methods: In total, 180 patients whose Scr levels had been rising after renal transplant were given an oral calcineurin inhibitor (CNI): either cyclosporine A (CsA) or tacrolimus (FK506). All patients were treated at People’s Hospital of Zhengzhou, China, between January 2011 and December 2013, and were given SRL-based conversion treatment. Scr level and glomerular filtration rate (GFR) were observed before and 1, 3, and 6 months after treatment initiation. In addition, liver function, blood glucose, blood lipid levels, rejection reaction incidence, and mortality were recorded to evaluate the effects of SRL. Results: Scr levels were 116.60 ± 30.60 μmol/L and 119.00 ± 24.60 μmol/L, and GFR was 70.00 ± 19.70 mL/min and 75.90 ± 15.60 mL/min, at 3 and 6 months after treatment, respectively. The 3- and 6- month Scr and GFR values were statistically different (p < 0.05) compared to pre-treatment levels (Scr: 144.10 ± 61.70 μmol/L vs and GFR: 59.10 ± 16.20 mL/min. Acute rejection (AR) occurred in 20 patients (13.30 %) within 6 months of treatment initiation, but rejection was reversed with conventional methylprednisolone therapy. Twenty-one patients (11.70 %) developed lung infections, but all were cured. There were no significant differences in liver function before and after treatment. Conclusion: SRL-based immunosuppressive therapy is effective in treating patients with increased Scr levels after renal transplant.

Five years retrospective cohort analysis of treatment outcomes of TB-HIV patients at a PEPFAR/DOTS Centre in South Eastern Nigeria.

Background: Human immunodeficiency virus (HIV) associated tuberculosis (TB) remains a major global public health challenge, with an estimated 1.4 million patients worldwide. Co-infection with HIV leads to challenges in the diagnosis and treatment of patients. Objectives: The aim of this study was to assess treatment outcomes of a cohort of smear positive TB-HIV co-infected patients over a five-year study period. Methods: A retrospective cohort study of 600 smear-positive tuberculosis patients registered at the chest unit of the University of Nigeria Teaching Hospital, Enugu from January 2008 to December 2012 was done. The data was analyzed using SPSS Version 17. Results: One hundred and three (17.2%) of the patients were co-infected with TB/HIV, while 398 (66.3%) and 99 (16.5%) were HIV negative and unknown respectively. Among the co-infected patients, 45(43.7%) were cured as against 222(55.8%) in the TBHIV negatives (Z=4.53, p=0.000, 95%CI= 0.12-0.34). Respectively in the TB-HIV co-infected and TB-HIV negative patients, treatment completed were 21(20.4%) and 71(17.8%) (Z=9.15, p=0.000, 95%= 0.4035-0.60); defaulted 19(18.5%) vs 70 (17.6%) (Z=9.29, p=0.000, 95%CI=0.42-0.60), died 10(9.7%) vs. 6(1.5%) (Z=1.22, p=0.224, 95%CI= -0.0286-0.1086), and failures were 1(0.9%) vs. 7(1.8%) (Z=2.48, p=0.013, 95%CI=0.04-0.10). Treatment success rate was lower in TB-HIV co-infected patients, 64.1% compared to TB-HIV negative patients with 73.6%. Also those that defaulted among the TB-HIV co-infected patients (18.5%) were higher than 17.6% among TB-HIV negative patients, a difference of 0.9%. Conclusion: Findings demonstrate that HIV co-infection affects TB treatment outcomes adversely. Treatment adherence, timely and sustained access to antiretroviral therapy for TB/HIV co-infected patients are important.