Einstein/Montefiore Department of Medicine

Department Faculty

Dr. James C.M. Brust, M.D.

James C.M. Brust, M.D.

Associate Professor, Department of Medicine (General Internal Medicine)

Areas of Research: Epidemiology and treatment outcomes of drug-resistant tuberculosis and HIV in South Africa. A particular focus is on novel therapeutics and emergence of resistance as drugs are introduced into the South African TB program.

Professional Interests

Dr. Brust is an Associate Professor of Medicine, with joint appointments in the Divisions of General Internal Medicine and Infectious Diseases. He graduated from College of Physicians & Surgeons at Columbia University and completed both a residency in Internal Medicine and a fellowship in Infectious Diseases at the Columbia University Medical Center. 

Dr. Brust's research has focused on the dual epidemics of multidrug-resistant tuberculosis (MDR TB) and HIV in South Africa.  He designed and implemented a novel, home-based treatment program for patients co-infected with HIV and MDR TB and was awarded a K23 Career Development grant from the NIAID to study the program. With collaborators at Emory University, CDC, PHRI-Rutgers and the University of KwaZulu-Natal, he has been defining and examining responses to the epidemic in KZN. His research group showed that the majority of drug-resistant TB in KwaZulu-Natal province is the result of person-to-person transmission, rather than inadequate treatment. He holds an R01 from NIAID to study the new TB medication, bedaquiline in patients with extensively drug-resistant (XDR) TB. This study, which includes investigators at the University of Cape Town will define the genetic mechanisms of resistance and drug-drug interactions with antiretroviral therapy as the drug is rolled out in South Africa. 

Current Investigations

  1. Safety, pharmacokinetics and mechansisms of resistance to bedaquiline in XDR TB and HIV (PI) 
  2. Prevalence and mechanisms of baseline nitroimidazole resistance in MDR and XDR TB (PI)
  3. Prospective cohort of MDR TB patients with and without HIV co-infection (Co-I)
  4. Molecular epidemiology of multidrug- and extensively drug-resistant tuberculosis in KwaZulu-Natal, South Africa (Co-I)
  5. Role of casual contact and migration in XDR TB transmission in South Africa: a geospatial, genomic and social network study (Co-I)
  6. High-resolution plasma metabolomic profiling to identify biomarkers for tuberculosis disease and response to therapy (Co-I)

Selected Publications

Brust JCM, Gandhi NR, Carrara H, Osburn G and Padayatchi N. High Treatment Failure and Default Rates for Patients with MDR TB in KwaZulu-Natal, South Africa, 2000-2003. Int J Tuberc Lung Dis. 2010;14(4):413-9


Brust JCM, Lygizos M, Chaiyachati K, Scott, M, van der Merwe TL, Moll AP, Li X, Loveday M, Bamber S, Lalloo UG, Friedland GH, Shah NS, and Gandhi NR. Culture conversion among HIV co-infected multidrug-resistant tuberculosis patients in Tugela Ferry, South Africa. PLoS One 6(1): e15841. doi:10.1371/journal.pone.0015841

 

Brust JCM, Litwin AH, Berg KM, Li X, Heo M, and Arnsten JH. Directly observed antiretroviral therapy in substance abusers receiving methadone maintenance therapy does not cause increased drug resistance. AIDS Res Hum Retroviruses. 2011; 27(5):535-41

 

Brust JCM, O’Donnell MR, and Metcalfe JZ. TB/HIV: An orphan disease? Am J Resp Crit Care Med. 2011; 183:1441-2

 

Gandhi NR, Andrews JR, Brust JCM, Montreuil R, Weissman D, Heo M, Moll AP, Friedland GH, Shah NS. Risk factors for mortality among MDR- and XDR-TB patients in a high HIV-prevalence setting. Int J Tuberc Lung Dis. 2012; 16(1):90-97


Brust JCM, Shah NS, Scott M, Chaiyachati K, Lygizos M, van der Merwe TL, Bamber S, Radebe Z, Loveday M, Moll AP, Margot B, Lalloo UG, Friedland GH, Gandhi NR. Integrated, home-based treatment for MDR-TB and HIV in rural South Africa: an alternate model of care. Int J Tuberc Lung Dis 2012; 16:998-1004.


Brust JCM, Shah NS, van der Merwe TL, Bamber S, Ning Y, Heo M, Moll AP, Loveday M, Lalloo UG, Friedland GH, Gandhi NR. Adverse events in an integrated, home-based treatment program for MDR-TB and HIV in KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr 2013; 62:436-440.


Brust JCM, Berman AR, Zalta B, Haramati LB, Ning Y, Heo H, van der Merwe TL, Bamber S, Moll AP, Friedland GH, Shah NS, Gandhi NR.Chest radiograph findings and time to culture conversion in patients with multidrug-resistant tuberculosis and HIV in Tugela Ferry, South Africa.PLoS One 2013; 8(9): e73975. doi:10.1371/journal.pone.0073975

 

Gandhi NR, Brust JCM, Moodley P, Weissman D, Heo M, Ning Y, Moll AP, Friedland GH, Sturm W, Shah NS. Low M. tuberculosis strain diversity among multidrug- and extensively drug-resistant tuberculosis isolates from Tugela Ferry, South Africa, 2005-2006. Emerg Infect Dis 2014; 20(3):394-401.

 

Loveday M, Padayatchi N, Wallengren K, Roberts J, Brust J, Ngozo J, Master I, Voce A. Association between health systems performance and treatment outcomes in patients co-infected with MDR-TB and HIV in KwaZulu-Natal, South Africa: Implications for TB programmes. PLoS ONE 2014 9(4): e94016. doi:10.1371/journal.pone.0094016

 

Loveday M, Wallengren K, Brust J, Roberts J, Voce A, Margot B, Ngozo J, Master I, Cassell G, Padayatchi N. Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa. Int J Tuberc Lung Dis. 2015 Feb;19(2):163-71.

 

Niehaus AJ, Gandhi NR, Mathema B, Mlisana K, Brust JCM. High prevalence of inhA promoter mutations among patients with drug-resistant tuberculosis in KwaZulu-Natal, South Africa. PLoS One 2015; 10(9):e0135003. doi: 10.1371/journal.pone.0135003

 

Shah NS, Auld S, Brust JCM, Mathema B, Ismail N, Moodley P, Mlisana K, Allana S, Campbell A, Mthiyane T, Morris N, Mpangase P, Vally Omar S, Brown T, Narenchania A, Shaskina E, Kapwata T, Kreiswirth B, Gandhi NR. Transmission of Extensively Drug-Resistant Tuberculosis in South Africa. N Engl J Med 2017; 376(3):243-253

 

Brust JCM, Shah NS, Mlisana K, Moodley P, Allana S, Campbell A, Johnson BA, Master I, Mthiyane T, Lachman S, Larkan L-M, Ning Y, Malik A, Smith JP, Gandhi NR. Improved survival and cure rates with concurrent treatment for MDR-TB/HIV co-infection in South Africa. Clin Infect Dis. 2018; 66(8):1246-1253.

 

Loveday M, Wallengren K, Besada D, Reddy T, Brust JCM, Voce A, Desai H, Ngozo J, Radebe Z, Master I, Padayatchi N, and Daviaud E. MDR-TB patients in KwaZulu-Natal, South Africa: cost-effectiveness of 5 models of care. PLoS One. 2018; 13(4):e0196003. doi: 10.1371/journal.pone.0196003

 

 

 

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Research Information