Science for Health
Our studies are based at NIMR and at the University of Cape Town, South Africa. Our interest is the modulation of the immune response in human tuberculosis by vitamin D and corticosteroids. Both studies rely on recently completed clinical trials: first, of the efficacy of vitamin D as an adjunct to the treatment of active tuberculosis; and second of prednisone versus placebo for treatment of the HIV-TB associated immune reconstitution inflammatory syndrome (TB-IRIS).
Immunopathology is a hallmark of tuberculosis, which is necessary for transmission of the disease and responsible for its sequelae, including death. TB-IRIS arises as a consequence of restoration of pathological immunity in HIV-infected persons with tuberculosis who receive antiretroviral therapy, and is an opportunity to better understand this phenomenon. It was unknown until our trial whether corticosteroids would be beneficial in reducing symptoms. Our demonstration that they are effective now focuses attention on a rich specimen bank to determine the mode of action so that more specific immune modulators of immunopathology in tuberculosis can potentially be discovered.
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The distribution of symptom scores in percentage at week 2 and 4 in 3 categories (deteriorated, no change, improved/resolved) is shown. There were significant differences between the 2 arms at week 2 (p=0.001) and week 4 (p=0.03).
© MRC National Institute for Medical Research
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