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Celebrating 100 Years of Health Sciences
Together with Professor Mark Nicol (Head of Microbiology
at UCT) and a research team, Professor Zar recently
published the first landmark papers showing the
usefulness of GeneXpert – a rapid way to diagnose TB that
simultaneously diagnoses drug-resistant disease – when
used in children. The studies, published in the leading
journals
Lancet Infectious Diseases
and
Clinical Infectious
Diseases
, showed that TB could be rapidly detected on
induced sputum or on nasal mucus in 75% of children with
culture-confirmed disease. Such findings have changed
global practice, with potential major impact for improving
diagnosis and treatment of childhood TB; the World
Health Organisation has recently recommended this as the
standard of care for children with suspected TB living in
areas of high HIV prevalence or drug resistance.
Prevention of TB in HIV-infected children has been another
strong area of research. Professor Zar and her group have
previously shown that isoniazid (INH), a drug used to
treat TB, was highly effective in reducing mortality and
preventing TB in HIV-infected children with advanced HIV/
AIDS. Building on this, a key recent publication showed
that INH had an additive effect to antiretroviral therapy
in preventing TB in such children. In 2012, Dr Lisa Frigati,
a MMed student supervised by Professor Zar, received
the best-publication award in the Department of Clinical
Sciences for a young investigator for this work, which was
published in the prestigious journal
Thorax
.
In a first for the African continent, Professor Zar recently
set up a birth cohort study (the Drakenstein Child Lung
Health Study), which is funded by the Bill and Melinda
Gates Foundation. This multidisciplinary study investigates
the determinants of pneumonia and the long-term impact
on child health with focus areas including nutrition,
infectious diseases, environmental exposures, psycho-
social factors, maternal and paternal health, and genetic
and immunological factors. To date, almost 500 pregnant
women have been enrolled and 260 babies born. There
are 13 postgraduate students working on different aspects
of the study; several have been awarded prestigious
national and international grants for sub-studies nested in
the Drakenstein cohort. Exciting preliminary results have
emerged from some of these areas, particularly those led
by Professor Mark Nicol (microbiology aspects), Professor
Landon Myer (epidemiological aspects), Professor Dan
Stein (psychosocial aspects) and Dr Aneesa Vanker
(environmental aspects). Another first for the African
continent is the use of infant lung function in this study,
which has been led by Dr Di Gray, a PhD student, for which
she received a Wellcome Trust training award. The pilot
results from infant lung-function testing indicate excellent
success in performing this, and substantial differences in
lung function in six-week-old infants compared to their
European or North American counterparts, suggesting an
innate vulnerability to pneumonia.
More recently, the research focus has expanded to include
a study of the health of HIV-infected adolescents, a growing
population with unique, but poorly understood, health
needs. Together with co-investigator Professor Landon
Myer, Professor Zar was awarded a large five-year grant
from the NIH to study the development and progression
of respiratory, cardiac and neurocognitive disease in a
cohort of HIV-infected adolescents. This multidisciplinary
research involves collaborators in the Departments of
Paediatrics and Child Health, Medicine, Public Health,
and Psychiatry, and the IIDMM, and has the potential to
identify mechanism of disease and novel preventative and
treatment strategies.
Such findings have changed global
practice, with potential major impact
for improving diagnosis and treatment
of childhood TB; the World Health
Organisation has recently recommended
this as the standard of care for children
with suspected TB living in areas of high
HIV prevalence or drug resistance.