Richard N. van Zyl-Smit1, Madhukar Pai2, Kwaku Peprah1, Richard Meldau1, Jackie Kieck3, June Juritz4, Motasim Badri1, Alimuddin Zumla5, Leonardo A. Sechi6, Eric D. Bateman1, and Keertan Dheda1,5,7

1Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute Department of Medicine, University of Cape Town, Cape Town, South Africa; 2Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; 3Department of Radiology, University of Cape Town and Groote Schuur Hospital, and 4Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa; 5Centre for Infectious Diseases and International Health, Royal Free and University College Medical School, London, United Kingdom; 6Dipartimento di Scienze Biomediche, University of Sardinia, Sassari, Italy; and 7Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa

Tuberculosis continues to be the world's most important infectious cause of morbity and mortality among adulsts. Nearly 9 million people develop TB disease each year, and an estimated 1.6 million die from the disease.Despite this enormous global burden, case detection rates are low, posing an enormous hurdle for TB control. Conventional TB diagnosis approaches continue to rely on century-old tests, such as sputum smear microscopy, solid media culture, tuberculin skin tests, and chest radiography. These tests have several limitations and perform quite poorly in populations affected by the HIV epidemic. For example, sputum smear microscopy using standard direct Ziehl-Neelsen (ZN) sttaing has low sensitivity in HIV-infected individuasl and, by definition, it is of no value in smear-negative TB. Smear microscopy is also unhelpful in many cases of extrapulmonary TB and childhood TB.

Gillian F. Black,1‡* Bonnie A. Thiel,2‡ Martin O. Ota,3 Shreemanta K. Parida,4 Richard Adegbola,3 W. Henry Boom,2,5 Hazel M. Dockrell,6 Kees L. M. C. Franken,7 Annemiek H. Friggen,7 Philip C. Hill,3§ Michel R. Klein,7¶ Maeve K. Lalor,6 Harriet Mayanja,5 Gary Schoolnik,8 Kim Stanley,1 Karin Weldingh,9  Stefan H. E. Kaufmann,4 Gerhard Walzl,1 Tom H. M. Ottenhoff,7 and the GCGH Biomarkers for TB Consortium Department of Biomedical Sciences, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa1; Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio2; Bacterial Diseases Programme, Medical Research Council, P.O. Box 273, Banjul, The Gambia3; Department of Immunology, Max Planck Institute for Infection Biology, D-10117 Berlin, Germany4; Department of Medicine, Makerere University, Kampala, Uganda5; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom6; Department of Immunohematology and Blood Transfusion, and Department of Infectious Diseases, Leiden University Medical Centre, NL-2300 RC Leiden, The Netherlands7; Department of Microbiology and Immunology, Stanford University, Stanford, California8; and Department of Infectious Disease Immunology, Statens Serum Institute, Copenhagen, Denmark9

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on-Erik C. Holty,1,2 Michael K. Gould,1,2,4 Laura Meinke,5 Emmet B. Keeffe,3 and Stephen J. Ruoss2 1Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA; Divisions of 2Pulmonary and Critical Care Medicine and 3Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA; 4VA Palo Alto Health Care System, Palo Alto, CA; and 5Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Arizona, Tucson, AZ

The dose of efavirenz during concomitant rifampin (RMP) administration is a matter of debate. We studied the influence of RMP coadministration on the steady-state pharmacokinetics of efavirenz in human immunodeficiency virus type 1 (HIV-1)-infected patients in South India. Fifty-seven HIV-tuberculosis (TB)-coinfected and 15 HIV-1-infected patients receiving combination antiretroviral therapy (CART) with an efavirenz (600 mg once daily)-containing regimen were recruited. HIV-TB-coinfected patients were receiving treatment with RMP-containing regimens. A complete pharmacokinetic study was conducted with 19 HIV-TB patients on two occasions (with and without RMP).

Thomas Haustein, MD,*†‡ Deborah A. Ridout, MSc,§ John C. Hartley, FRCPath,*†‡ Urvashi Thaker, MSc,*†‡ Delane Shingadia, FRCPCH, MPH,¶ Nigel J. Klein, PhD,¶ Vas Novelli, FRCP,¶ and Garth L. J. Dixon, PhD*†‡

Urban Sester1, Heinrike Wilkens2, Kai van Bentum1, Mahavir Singh3, Gerhard W. Sybrecht2, Hans-Joachim Schäfers4, and Martina Sester1

1Department of Internal Medicine IV, 2Department of Internal Medicine V, 3Helmholtz Center for Infection Research, and Lionex GmbH, Inhoffenstraße 7, D-38124 Braunschweig, Germany, 4Department of thoracic and cardiovascular surgery, University of the Saarland, D-66421 Homburg, Germany

Short title: TB immunity on immunosuppression

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