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Geiger K, Patil A, Budhathoki C, Dooley KE, Lowensen K, Ndjeka N, Ngozo J, Farley JE. Relationship between HIV viral suppression and multidrug resistant tuberculosis treatment outcomes. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002714. [PMID: 38709764 PMCID: PMC11073678 DOI: 10.1371/journal.pgph.0002714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/05/2024] [Indexed: 05/08/2024]
Abstract
The impact of HIV viral suppression on multidrug resistant tuberculosis (MDR-TB) treatment outcomes among people with HIV (PWH) has not been clearly established. Using secondary data from a cluster-randomized clinical trial among people with MDR-TB in South Africa, we examined the effects of HIV viral suppression at MDR-TB treatment initiation and throughout treatment on MDR-TB outcomes among PWH using multinomial regression. This analysis included 1479 PWH. Viral suppression (457, 30.9%), detectable viral load (524, 35.4%), or unknown viral load (498, 33.7%) at MDR-TB treatment initiation were almost evenly distributed. Having a detectable HIV viral load at MDR-TB treatment initiation significantly increased risk of death compared to those virally suppressed (relative risk ratio [RRR] 2.12, 95% CI 1.11-4.07). Among 673 (45.5%) PWH with a known viral load at MDR-TB outcome, 194 (28.8%) maintained suppression, 267 (39.7%) became suppressed, 94 (14.0%) became detectable, and 118 (17.5%) were never suppressed. Those who became detectable (RRR 11.50, 95% CI 1.98-66.65) or were never suppressed (RRR 9.28, 95% CI 1.53-56.61) were at significantly increased risk of death (RRR 6.37, 95% CI 1.58-25.70), treatment failure (RRR 4.54, 95% CI 1.35-15.24), and loss to follow-up (RRR 7.00, 95% CI 2.83-17.31; RRR 2.97, 95% CI 1.02-8.61) compared to those who maintained viral suppression. Lack of viral suppression at MDR-TB treatment initiation and failure to achieve or maintain viral suppression during MDR-TB treatment drives differences in MDR-TB outcomes. Early intervention to support access and adherence to antiretroviral therapy among PWH should be prioritized to improve MDR-TB treatment outcomes.
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Affiliation(s)
- Keri Geiger
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Amita Patil
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kelly E. Dooley
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Kelly Lowensen
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Norbert Ndjeka
- National Department of Health, Tuberculosis Control and Management, Pretoria, Gauteng, South Africa
| | - Jacqueline Ngozo
- KwaZulu-Natal Department of Health, Tuberculosis Programme, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Jason E. Farley
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, Baltimore, Maryland, United States of America
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Chanda E. The clinical profile and outcomes of drug resistant tuberculosis in Central Province of Zambia. BMC Infect Dis 2024; 24:364. [PMID: 38556907 PMCID: PMC10983631 DOI: 10.1186/s12879-024-09238-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/19/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The emergence of Drug Resistant Tuberculosis (DR-TB) is one of the main public health and economic problems facing the world today. DR-TB affects mostly those in economically productive years and prevents them from being part of the workforce needed for economic growth. The aim of this study was to determine the Clinical Profile and Outcomes of DR-TB in Central Province of Zambia. METHODS This was a retrospective cross sectional study that involved a review of records of patients with confirmed DR-TB who were managed at Kabwe Central Hospital's Multi-Drug Resistant TB (MDR-TB) Ward from the year 2017 to 2021. 183 patients were managed during this period and all were recruited in the study. Data was collected from DR-TB registers and patient files and then entered in SPSS version 22 where all statistical analyses were performed. RESULTS The study revealed that the prevalence of DR-TB among registered TB patients in Central Province was 1.4%. Majority of those affected were adults between the ages of 26 and 45 years (63.9%). The study also found that more than half of the patients were from Kabwe District (60.7%). Other districts with significant number of cases included Kapiri Mposhi 19 (10.4%), Chibombo 12 (6.6%), Chisamba 10 (5.5%), Mumbwa 7 (3.8%) and Mkushi 7 (3.8%). Furthermore, the analysis established that most of the patients had RR-TB (89.6%). 9.3% had MDR-TB, 0.5% had IR-TB and 0.5% had XDR-TB. RR-TB was present in 93.8% of new cases and 88.9% of relapse cases. MDR-TB was present in 6.2% of new cases and 10% of relapse cases. With regard to outcomes of DR-TB, the investigation revealed that 16.9% of the patients had been declared cured, 45.9% had completed treatment, 6% were lost to follow up and 21.3% had died. Risk factors for mortality on multivariate analysis included age 36-45 years (adjusted odds ratio [aOR] 0.253, 95% CI [0.70-0.908] p = 0.035) and male gender (aOR 0.261, 95% CI [0.107-0.638] p = 0.003). CONCLUSION The research has shown beyond doubt that the burden of DR-TB in Central Province is high. The study recommends putting measures in place that will help improve surveillance, early detection, early initiation of treatment and proper follow up of patients.
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Affiliation(s)
- Evaristo Chanda
- Department of Public Health, Texila American University, Lusaka, Zambia.
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Dheda K, Mirzayev F, Cirillo DM, Udwadia Z, Dooley KE, Chang KC, Omar SV, Reuter A, Perumal T, Horsburgh CR, Murray M, Lange C. Multidrug-resistant tuberculosis. Nat Rev Dis Primers 2024; 10:22. [PMID: 38523140 DOI: 10.1038/s41572-024-00504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/26/2024]
Abstract
Tuberculosis (TB) remains the foremost cause of death by an infectious disease globally. Multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB; resistance to rifampicin and isoniazid, or rifampicin alone) is a burgeoning public health challenge in several parts of the world, and especially Eastern Europe, Russia, Asia and sub-Saharan Africa. Pre-extensively drug-resistant TB (pre-XDR-TB) refers to MDR/RR-TB that is also resistant to a fluoroquinolone, and extensively drug-resistant TB (XDR-TB) isolates are additionally resistant to other key drugs such as bedaquiline and/or linezolid. Collectively, these subgroups are referred to as drug-resistant TB (DR-TB). All forms of DR-TB can be as transmissible as rifampicin-susceptible TB; however, it is more difficult to diagnose, is associated with higher mortality and morbidity, and higher rates of post-TB lung damage. The various forms of DR-TB often consume >50% of national TB budgets despite comprising <5-10% of the total TB case-load. The past decade has seen a dramatic change in the DR-TB treatment landscape with the introduction of new diagnostics and therapeutic agents. However, there is limited guidance on understanding and managing various aspects of this complex entity, including the pathogenesis, transmission, diagnosis, management and prevention of MDR-TB and XDR-TB, especially at the primary care physician level.
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Affiliation(s)
- Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa.
- Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK.
| | - Fuad Mirzayev
- Global Tuberculosis Programme, WHO, Geneva, Switzerland
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute Milan, Milan, Italy
| | - Zarir Udwadia
- Department of Pulmonology, Hinduja Hospital & Research Center, Mumbai, India
| | - Kelly E Dooley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kwok-Chiu Chang
- Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong, SAR, China
| | - Shaheed Vally Omar
- Centre for Tuberculosis, National & WHO Supranational TB Reference Laboratory, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Molecular Medicine & Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Anja Reuter
- Sentinel Project on Paediatric Drug-Resistant Tuberculosis, Boston, MA, USA
| | - Tahlia Perumal
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
- Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | - C Robert Horsburgh
- Department of Epidemiology, Boston University Schools of Public Health and Medicine, Boston, MA, USA
| | - Megan Murray
- Department of Epidemiology, Harvard Medical School, Boston, MA, USA
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), TTU-TB, Borstel, Germany
- Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
- Department of Paediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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Geiger K, Patil A, Bergman A, Budhathoki C, Heidari O, Lowensen K, Mthimkhulu N, McNabb KC, Ndjeka N, Ngozo J, Reynolds N, Farley JE. Exploring HIV disease indicators at MDR-TB treatment initiation in South Africa. Int J Tuberc Lung Dis 2024; 28:42-50. [PMID: 38178293 PMCID: PMC10915896 DOI: 10.5588/ijtld.23.0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND: Understanding relationships between HIV and multidrug-resistant TB (MDR-TB) is crucial for ensuring successful MDR-TB outcomes.METHODS: We used a cross-sectional analysis to evaluate sociodemographic and clinical characteristics as correlates of antiretroviral therapy (ART) use, having an HIV viral load (VL) result, and HIV viral suppression in a cross-sectional sample of people with HIV (PWH) and MDR-TB enrolled in a cluster-randomized trial of nurse case management to improve MDR-TB outcomes.RESULTS: Among 1,479 PWH, the mean age was 37.1 years; 809 (54.7%) were male, and 881 (59.6%) were taking ART. Housing location, employment status, and CD4 count differed significantly between those taking vs. those not taking ART. Among the 881 taking ART, 681 (77.3%) had available HIV VL results. Housing location, CD4 count, and prior history of TB differed significantly between those with and without a VL result. Among the 681 with a VL result, 418 (61.4%) were virally suppressed. Age, education level, CD4 count, TB history, housing location, and ART type differed significantly between those with and without viral suppression.CONCLUSION: PWH presenting for MDR-TB treatment with a history of TB, taking a protease inhibitor, or living in a township may risk poor MDR-TB outcomes.
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Affiliation(s)
- Keri Geiger
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Amita Patil
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Durban, Republic of South Africa
| | - Alanna Bergman
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | | | - Omeid Heidari
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
- University of Washington School of Nursing, Seattle, WA, USA
| | - Kelly Lowensen
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Durban, Republic of South Africa
| | - Nomusa Mthimkhulu
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Durban, Republic of South Africa
| | - Katherine C. McNabb
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Norbert Ndjeka
- National Department of Health, Republic of South Africa, TB Control and Management
| | - Jaqueline Ngozo
- KwaZulu Natal Department of Health, Republic of South Africa
| | - Nancy Reynolds
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Jason E. Farley
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Durban, Republic of South Africa
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Bayowa JR, Kalyango JN, Baluku JB, Katuramu R, Ssendikwanawa E, Zalwango JF, Akunzirwe R, Nanyonga SM, Amutuhaire JS, Muganga RK, Cherop A. Mortality rate and associated factors among patients co-infected with drug resistant tuberculosis/HIV at Mulago National Referral Hospital, Uganda, a retrospective cohort study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001020. [PMID: 37410761 DOI: 10.1371/journal.pgph.0001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
Drug resistant tuberculosis (DR-TB)/HIV co-infection remains a growing threat to public health and threatens global TB and HIV prevention and care programs. HIV is likely to worsen the outcomes of DR-TB and DR-TB is likely to worsen the outcomes of HIV despite the scale up of TB and HIV services and advances in treatment and diagnosis. This study determined the mortality rate and factors associated with mortality among persons on treatment co-infected with drug resistant TB and HIV at Mulago National Referral Hospital. We retrospectively reviewed data of 390 persons on treatment that had a DR-TB/HIV co-infection in Mulago National Referral Hospital from January 2014 to December 2019.Modified poisson regression with robust standard errors was used to determine relationships between the independent variables and the dependent variable (mortality) at bivariate and multivariate analysis. Of the 390 participants enrolled, 201(53.9%) were males with a mean age of 34.6 (±10.6) and 129 (33.2%,95% CI = 28.7-38.1%) died. Antiretroviral therapy(ART) initiation (aIRR 0.74, 95% CI = 0.69-0.79), having a body mass index (BMI)≥18.5Kg/m2 (aIRR 1.01, 95% CI = 1.03-1.17), having a documented client phone contact (aIRR 0.85, 95% CI = 0.76-0.97), having a mid-upper arm circumference,(MUAC) ≥18.5cm (aIRR 0.90, 95% CI = 0.82-0.99), being on first and second line ART regimen (aIRR 0.83, 95% CI = 0.77-0.89),having a known viral load (aIRR 1.09, 95% CI = 1.00-1.21) and having an adverse event during the course of treatment (aIRR 0.88, 95% CI = 0.83-0.93) were protective against mortality. There was a significantly high mortality rate due to DR-TB/HIV co-infection. These results suggest that initiation of all persons living with HIV/AIDS (PLWHA) with DR-TB on ART and frequent monitoring of adverse drug events highly reduces mortality.
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Affiliation(s)
- Joan Rokani Bayowa
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joan N Kalyango
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Richard Katuramu
- Ministry of Health, Tuberculosis Control Program, Kampala, Uganda
| | - Emmanuel Ssendikwanawa
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jane Frances Zalwango
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rebecca Akunzirwe
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Stella Maris Nanyonga
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Ronald Kivumbi Muganga
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Adolphus Cherop
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
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Wang MG, Liu XM, Wu SQ, He JQ. Impacts of clofazimine on the treatment outcomes of drug-resistant tuberculosis. Microbes Infect 2023; 25:105020. [PMID: 35792202 DOI: 10.1016/j.micinf.2022.105020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this research was to evaluate the effect of clofazimine on drug-resistant tuberculosis treatment outcomes. METHODS A systematic search was conducted in the PubMed, Web of Science and EMBASE databases to identify eligible studies published up to July 10, 2021. The search terms were as follows: "clofazimine," "tuberculosis," "multidrug resistant tuberculosis" or "extensively drug resistant tuberculosis" and their synonyms or similar words. Two researchers independently screened the titles, abstracts, and full texts for inclusion. Meta-analysis was performed with Stata version 16.0 (Stata Corp., College Station, Texas, USA). Risk ratios (RRs) with 95% CIs were calculated to evaluate the treatment outcome. RESULTS Eight studies including 3219 participants were included in the meta-analysis. The meta-analysis found that the rates of treatment completion was higher in patients receiving clofazimine-containing regimens than in those not receiving clofazimine-containing regimens (RR: 1.185 (1.060-1.325), P = 0.003). Significant reduction in treatment failure (RR: 0.598 (0.473-0.756), P < 0.001) was found in the clofazimine treatment group. The subgroup analyses of randomized controlled trials (RCTs) found a higher rates of favorable outcomes, treatment completion and cure in the clofazimine group than in the control group (RR: 1.203 (1.029-1.407), P = 0.020; RR: 3.167 (2.043-4.908), P < 0.001; and RR: 1.251 (1.031-1.518), P = 0.023, respectively). Patients receiving clofazimine had a lower risk of treatment failure than those not receiving clofazimine (RR: 0.529 (0.454-0.616), P < 0.001). However, clofazimine treatment did not have a statistically significant effect on all-cause mortality in RCTs. CONCLUSIONS This study demonstrated that compared with patients who do not receive clofazimine, this drug has the potential to achieve a higher favorable outcome, treatment completion and cure rates, and a lower treatment failure risk among drug-resistant tuberculosis cases.
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Affiliation(s)
- Ming-Gui Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China
| | - Xiang-Min Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China; West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, PR China
| | - Shou-Quan Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China
| | - Jian-Qing He
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China.
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Anderson K, Pietersen E, Shepherd BE, Bian A, Dheda K, Warren R, Sterling TR, van der Heijden YF. High mortality among patients hospitalized for drug-resistant tuberculosis with acquired second-line drug resistance and high HIV prevalence. HIV Med 2022; 23:1085-1097. [PMID: 35608016 PMCID: PMC9588462 DOI: 10.1111/hiv.13318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We compared mortality between HIV-positive and HIV-negative South African adults with drug-resistant tuberculosis (DR-TB) and high incidence of acquired second-line drug resistance. METHODS We performed a retrospective review of DR-TB patients with serial second-line TB drug susceptibility tests (2008-2015) who were hospitalized at a specialized TB hospital. We used Kaplan-Meier analysis and Cox models to examine associations with mortality. RESULTS Of 245 patients, the median age was 33 years, 54% were male and 40% were HIV-positive, 96% of whom had ever received antiretroviral therapy (ART). At initial drug resistance detection, 99% of patients had resistance to at least rifampicin and isoniazid, and 18% had second-line drug resistance (fluoroquinolones and/or injectable drugs). At later testing, 88% of patients had acquired additional second-line drug resistance. Patient-initiated treatment interruptions (> 2 months) occurred in 47%. Mortality was 79%. Those with HIV had a shorter time to death (p = 0.02; log-rank): median survival time from DR-TB treatment initiation was 2.44 years [95% confidence interval (CI): 2.09-3.15] versus 3.99 years (95% CI: 3.12-4.75) for HIV-negative patients. HIV-positive patients who received ART within 6 months before DR-TB treatment had a higher mortality hazard than HIV-negative patients [adjusted hazard ratio (aHR) ratio = 1.82, 95% CI: 1.21-2.74]. By contrast, HIV-positive patients who did not receive ART within 6 months before DR-TB treatment did not have a significantly higher mortality hazard than HIV-negative patients (aHR = 1.09; 95% CI: 0.72-1.65), although those on ART had lower median CD4 counts than those not on ART (157 vs. 281 cells/μL, respectively; p = 0.02). CONCLUSIONS A very high incidence of acquired second-line drug resistance and high overall mortality were observed, reinforcing the need to reduce the risk of acquired resistance and for more effective treatment.
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Affiliation(s)
- Kim Anderson
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung InstituteUniversity of Cape TownCape TownSouth Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Elize Pietersen
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung InstituteUniversity of Cape TownCape TownSouth Africa
| | - Bryan E. Shepherd
- Department of BiostatisticsVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Aihua Bian
- Department of BiostatisticsVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung InstituteUniversity of Cape TownCape TownSouth Africa
- South African MRC Centre for the Study of Antimicrobial ResistanceUniversity of Cape TownCape TownSouth Africa
- Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical MedicineLondonUK
| | - Robin Warren
- DST‐NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for TB Research/Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Timothy R. Sterling
- Vanderbilt Tuberculosis CenterVanderbilt University School of MedicineNashvilleTennesseeUSA
- Division of Infectious Diseases, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Yuri F. van der Heijden
- Vanderbilt Tuberculosis CenterVanderbilt University School of MedicineNashvilleTennesseeUSA
- Division of Infectious Diseases, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
- The Aurum InstituteJohannesburgSouth Africa
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Kokebu DM, Ahmed S, Moodliar R, Chiang CY, Torrea G, Van Deun A, Goodall RL, Rusen ID, Meredith SK, Nunn AJ. Failure or relapse predictors for the STREAM Stage 1 short regimen for RR-TB. Int J Tuberc Lung Dis 2022; 26:753-759. [PMID: 35898125 PMCID: PMC9341498 DOI: 10.5588/ijtld.22.0073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: STREAM (Standardised Treatment Regimens of Anti-tuberculosis drugs for Multidrug-Resistant Tuberculosis) Stage 1 demonstrated non-inferior efficacy of a short regimen for rifampicin-resistant TB (RR-TB) compared to a long regimen as recommended by the WHO. The present paper analyses factors associated with a definite or probable failure or relapse (FoR) event in participants receiving the Short regimen.METHODS: This analysis is restricted to 253 participants allocated to the Short regimen and is based on the protocol-defined modified intention to treat (mITT) population. Multivariable Cox regression models were built using backwards elimination with an exit probability of P = 0.157, equivalent to the Akaike Information Criterion, to identify factors independently associated with a definite or probable FoR event.RESULTS: Four baseline factors were identified as being significantly associated with the risk of definite or probable FoR (male sex, a heavily positive baseline smear grade, HIV co-infection and the presence of costophrenic obliteration). There was evidence of association of culture positivity at Week 8 and FoR in a second model and Week 16 smear positivity, presence of diabetes and of smoking in a third model.CONCLUSION: The factors associated with FoR outcomes identified in this analysis should be considered when determining the optimal shortened treatment regimen.
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Affiliation(s)
- D. M. Kokebu
- St Peter’s Tuberculosis Specialised Hospital/Global Health Committee, Addis Ababa, Ethiopia
| | - S. Ahmed
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - R. Moodliar
- Tuberculosis & HIV Investigative Network (THINK), Doris Goodwin Hospital, Pietermaritzburg, South Africa
| | - C-Y. Chiang
- Division of Pulmonary Medicine, Department of Internal Medicine, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
, Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - G. Torrea
- Institute of Tropical Medicine, Antwerp, Belgium
| | - A. Van Deun
- Institute of Tropical Medicine, Antwerp, Belgium
| | - R. L. Goodall
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - I. D. Rusen
- Research Division, Vital Strategies, New York, USA
| | - S. K. Meredith
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A. J. Nunn
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
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Wu Y, Zhang Y, Wang Y, Wei J, Wang W, Duan W, Tian Y, Ren M, Li Z, Wang W, Zhang T, Wu H, Huang X. Bedaquiline and Linezolid improve anti-TB treatment outcome in drug-resistant TB patients with HIV: A systematic review and meta-analysis. Pharmacol Res 2022; 182:106336. [PMID: 35779814 DOI: 10.1016/j.phrs.2022.106336] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES We aimed to assess the effect of second-line anti-TB treatment and determine which drugs can achieve the greatest clinical benefit for DR-TB-HIV patients by comparing multiple chemotherapy regimens, to provide a basis for evidence-based practice. METHODS We searched three electronic databases (PubMed, Web of Science and Cochrane) for related English studies published since 2010. A random-effect model was used to estimate the pooled result for the treatment outcomes. Subgroup analysis based on possible factors, such as ART, baseline CD4 T-cell count, treatment regimens, and profiles of drug resistance, was also conducted to assess factors for favorable outcome. Outcomes were treatment success and mortality. RESULTS 38 studies, 40 cohorts with 9279 patients were included. The pooled treatment success, mortality, treatment failure, and default rates were 57.5 % (95 % CI 53.1-61.9), 21 % (95 % CI 17.8-24.6), 4.8 % (95 % CI 3.5-6.5), and 10.7 % (95 % CI 8.7-13.1), respectively, in patients with DR-TB and HIV co-infection. Subgroup analysis showed that BDQ and LZD based regimen, and ≥ 2 Group A drugs were associated with a higher treatment success rate. Besides, higher CD4 T-cell count at baseline was also correlated with higher treatment success rate, too. CONCLUSIONS Suboptimal anti-TB outcomes underlining the need to expand the application of effective drugs and better regimen in high HIV setting. BDQ and LZD based all-oral regimen and early ART could contribute to higher treatment success, particularly among XDR-TB-HIV patients. Given that all included studies were observational, our findings emphasize the need for high-quality studies to further investigate the optimal treatment regimen for DR-TB-HIV.
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Affiliation(s)
- Yaxin Wu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Yuening Zhang
- Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Yingying Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Jiaqi Wei
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China; Beijing Key Laboratory for HIV/AIDS Research, Beijing Youan Hospital, Capital Medical University, Beijing100069, China
| | - Wenjing Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Wenshan Duan
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Yakun Tian
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Meixin Ren
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Zhen Li
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China; Beijing Key Laboratory for HIV/AIDS Research, Beijing Youan Hospital, Capital Medical University, Beijing100069, China
| | - Wen Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Hao Wu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Xiaojie Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China.
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10
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Lungu P, Njelesani E, Sukwa T, Ngalamika O, Munsaka S, Kilembe W, Lakhi S, Mwaba P. Immune correlates of Mycobacterium Tuberculosis patients in Zambia stratified by HIV serostatus and level of immunity-a cross-sectional analytical laboratory based study. PLoS One 2022; 17:e0262454. [PMID: 35025927 PMCID: PMC8758034 DOI: 10.1371/journal.pone.0262454] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/23/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND People living with HIV (PLHIV) co-infected with tuberculosis (TB) have a distinct clinical presentation and poorer treatment outcomes compared to HIV-seronegative TB patients. Excluding low CD4 count, innate immune factors associated with TB are not fully elucidated. We, therefore, characterised and compared the expression of IL-6, TNF-α, IFN-γ, and IL-10 in whole blood of treatment naïve TB patients stimulated with heat-killed Mycobacterium tuberculosis stratified by HIV status and the level of CD4 count. RESULTS We recruited 39 HIV seropositive and 31 HIV seronegative TB patients. Median (IQR) age was 35(28-42) years and 31(25-36) years respectively, and a majority had pulmonary tuberculosis i.e. 38(95%) and 30(97%), respectively. The two groups were significantly different in the distribution of CD4 count, 563 [465-702.5 cells/mm3] vs 345 [157-483 cell/mm3] in HIV negative vs HIV positive respectively p = <0.001. Post stimulation, the expression of IL-6 in HIV negative TB patients was significantly higher than in the HIV positive 16,757366 [8,827-23,686 pg/ml] vs. 9,508 [5,514-15,008 pg/ml], respectively; p = 0.0360. TNF-α and IFN-γ were highly expressed in HIV negative TB patients compared to the HIV positive though not statistically significant. We only observed higher expression of IL-6 in HIV negative patients in comparison to the HIV positive when stratified by level of CD4 counts as < 500 and ≥ 500 cell/mm3 for both cohorts. 21,953 [8,990-24,206 pg/ml] vs 9,505 [5,400-15,313 pg/ml], p value = 0.0585 in patients with CD4 count < 500 cell/mm3 and 13,168 [7,087-22,584 pg/ml] vs 10,413 [7,397-14,806 pg/ml], p value = 0.3744 for patients with CD4 count of ≥ 500 cell/mm3 respectively. We found a positive pairwise correlation between TNF-α -alpha and IL-6 in both HIV positive and HIV negative patients, r = 0.61 (95% CI 0.36-0.72; p < 0.0001) and r = 0.48 (95% CI 0.15-0.68; p = 0.005) respectively. The IFNγ/IL-10 ratio was higher in HIV negative when compared to HIV positive individuals, 0.052 [0.0-0.28] vs 0.007 [0-0.32] respectively; p = 0.05759. IL-6 independently reduced the probability of TB/HIV, Adjusted odds ratio 0.99, p value 0.007. CONCLUSIONS This study suggests that HIV seronegative TB patients have a higher pro-inflammatory response to MTB than HIV seropositive TB patients. Further, it also shows that the level of CD4 influences immunomodulation. The findings suggest that the difference in cytokine expression may be responsible for the distinct patterns of TB presentation between HIV positive and HIV negative patient.
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Affiliation(s)
- Patrick Lungu
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Evarist Njelesani
- Faculty of Medicine and Directorate of Postgraduate Studies, Lusaka Apex Medical University, Lusaka, Zambia
| | - Thomas Sukwa
- Faculty of Medicine and Directorate of Postgraduate Studies, Lusaka Apex Medical University, Lusaka, Zambia
| | - Owen Ngalamika
- Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Sody Munsaka
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | | | - Shabir Lakhi
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Peter Mwaba
- Faculty of Medicine and Directorate of Postgraduate Studies, Lusaka Apex Medical University, Lusaka, Zambia
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11
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Spies R, Schutz C, Ward A, Balfour A, Shey M, Nicol M, Burton R, Sossen B, Wilkinson R, Barr D, Meintjes G. Rifampicin resistance and mortality in patients hospitalised with HIV-associated tuberculosis. South Afr J HIV Med 2022; 23:1396. [PMID: 36299556 PMCID: PMC9575347 DOI: 10.4102/sajhivmed.v23i1.1396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background Patients with HIV and drug-resistant tuberculosis (TB) are at high risk of death. Objectives We investigated the association between rifampicin-resistant TB (RR-TB) and mortality in a cohort of patients who were admitted to hospital at the time of TB diagnosis. Method Adults hospitalised at Khayelitsha Hospital and diagnosed with HIV-associated TB during admission, were enrolled between 2013 and 2016. Clinical, biochemical and microbiological data were prospectively collected and participants were followed up for 12 weeks. Results Participants with microbiologically confirmed TB (n = 482) were enrolled a median of two days (interquartile range [IQR]: 1-3 days) following admission. Fifty-three participants (11.0%) had RR-TB. Participants with rifampicin-susceptible TB (RS-TB) received appropriate treatment a median of one day (IQR: 1-2 days) following enrolment compared to three days (IQR: 1-9 days) in participants with RR-TB. Eight participants with RS-TB (1.9%) and six participants with RR-TB (11.3%) died prior to the initiation of appropriate treatment. Mortality at 12 weeks was 87/429 (20.3%) in the RS-TB group and 21/53 (39.6%) in the RR-TB group. RR-TB was a significant predictor of 12-week mortality (hazard ratio: 1.88; 95% confidence interval: 1.07-3.29; P = 0.03). Conclusion Mortality at 12 weeks in participants with RR-TB was high compared to participants with RS-TB. Delays in the initiation of appropriate treatment and poorer regimen efficacy are proposed as contributors to higher mortality in hospitalised patients with HIV and RR-TB.
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Affiliation(s)
- Ruan Spies
- Department of Medicine, New Somerset Hospital, Cape Town, South Africa
| | - Charlotte Schutz
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Amy Ward
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Avuyonke Balfour
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Muki Shey
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mark Nicol
- Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Rosie Burton
- Médecins sans Frontières, Cape Town, South Africa
| | - Bianca Sossen
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Robert Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,The Francis Crick Institute, London, United Kingdom.,Department of Infectious Disease, University College London, London, United Kingdom
| | - David Barr
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Graeme Meintjes
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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12
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Tabriz N, Nurtazina ZB, Kozhamuratov MT, Skak K, Mutaikhan Z. Effects of secondary infections on the multidrug-resistant Tuberculosis: A cohort study. Med J Islam Repub Iran 2021; 35:105. [PMID: 34956951 PMCID: PMC8683780 DOI: 10.47176/mjiri.35.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Tuberculosis (TB) causes over a million deaths annually and is still one of the most important public health problems worldwide. According to the World Health Organization estimates, the highest rates of TB in the European Region are in Tajikistan, Kazakhstan, Moldova, Kyrgyzstan, Romania, and Uzbekistan. The purpose of this study was to investigate the spectrum of nonspecific microorganisms isolated in patients with multidrug-resistant TB in Central Kazakhstan and to assess their susceptibility to antimicrobial drugs.
Methods: The patients were divided into 2 groups: group 1 with multidrug-resistant forms of pulmonary TB (n = 107 patients); group 2 with sensitive forms of pulmonary TB (n = 122 patients). Gender, age, and social status of the patients were studied. Microorganisms were identified using the MALDI-TOF method. The statistical significance of different values for binary and nominal parameters was determined using the chi-square test. Changes in binary variables were analyzed using the McNeimer test.
Results: During the study, an expectedly high proportion of tetracycline-resistant pneumococcal strains (66.7% and 60%, respectively) was isolated, which was a consequence of a long-term and practically uncontrolled use of these drugs in Kazakhstan. Fluoroquinolones showed low activity. The results showed that beta-lactam antibacterial drugs maintained their high activity against the causative agents of pneumococcal infection.
Conclusion: It was concluded that secondary microorganisms isolated in patients with multidrug-resistant TB were represented by the strains that were resistant to modern antibacterial drugs. Therefore, for appropriate antibiotic prescription, it is necessary to study materials from the respiratory system in all patients admitted for TB treatment to study the spectrum of nonspecific microorganisms and assess their susceptibility to antimicrobial drugs.
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Affiliation(s)
- Nurlan Tabriz
- Department of Infectious Diseases and Phthisiatrics, Karaganda Medical University, Karaganda, Republic of Kazakhstan
| | - Zhanara B Nurtazina
- Department of Infectious Diseases and Phthisiatrics, Karaganda Medical University, Karaganda, Republic of Kazakhstan
| | - Margulan T Kozhamuratov
- Department of Infectious Diseases and Phthisiatrics, Karaganda Medical University, Karaganda, Republic of Kazakhstan
| | - Kuliya Skak
- Department of Infectious Diseases and Phthisiatrics, Karaganda Medical University, Karaganda, Republic of Kazakhstan
| | - Zhumat Mutaikhan
- Department of Infectious Diseases and Phthisiatrics, Karaganda Medical University, Karaganda, Republic of Kazakhstan
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13
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Alayu Alemu M, Yesuf A, Girma F, Adugna F, Melak K, Biru M, Seyoum M, Abiye T. Impact of HIV-AIDS on tuberculosis treatment outcome in Southern Ethiopia - A retrospective cohort study. J Clin Tuberc Other Mycobact Dis 2021; 25:100279. [PMID: 34667883 PMCID: PMC8507186 DOI: 10.1016/j.jctube.2021.100279] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally, the Tuberculosis treatment success rate was worse for HIV-positive TB patients compared with HIV- negative TB patients. This study aimed at determining the impact of HIV-AIDS and factors associated with TB treatment outcomes. METHODS This study was a retrospective cohort study of five years of tuberculosis data from four public health facilities in Hosanna Town. A total of 604 study participants were included using a systematic random sampling technique. Descriptive analysis of ratios, rates, and proportions was done and binary logistic regression, bivariable and multivariable, analysis was also done. RESULT A total of 604 TB patients were enrolled in this study. 302 (50%) were HIV co-infected. The overall treatment success rate was 90.1% (544/604). Treatment success rates are 86.4% (261/302) for TB-HIV co-infected patients and 93.7% (283/302) for non-co-infected patients. TB-HIV co-infected patients had a higher risk of an unsuccessful treatment outcome (Adjusted Relative Risk [ARR]: 2.7; 95% Confidence Interval [CI]: 1.4 - 5.2). The risk of unsuccessful treatment outcome is also higher among rural residents (ARR: 3.3; CI: 1.4 - 5.0), patients on the re-treatment category (ARR: 2.7; CI: 1.4 - 5.1), and with chronic disease (ARR: 3.3; CI: 1.3 - 8.1). CONCLUSION TB treatment success rate is good as compared to the WHO minimum requirement. Successful treatment outcome is lower among patients with HIV infection, rural residents, patients on re-treatment, and patients with chronic disease. Therefore, due emphasis should be given to these high-risk groups.
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Affiliation(s)
| | - Aman Yesuf
- St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Fikirte Girma
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fanna Adugna
- St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Mengistu Biru
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Melaku Seyoum
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tesfahun Abiye
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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14
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Habimana DS, Ngabonziza JCS, Migambi P, Mucyo-Habimana Y, Mutembayire G, Byukusenge F, Habiyambere I, Remera E, Mugwaneza P, Mwikarago IE, Mazarati JB, Turate I, Nsanzimana S, Decroo T, de Jong CB. Predictors of Rifampicin-Resistant Tuberculosis Mortality among HIV-Coinfected Patients in Rwanda. Am J Trop Med Hyg 2021; 105:47-53. [PMID: 33999845 PMCID: PMC8274780 DOI: 10.4269/ajtmh.20-1361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/26/2021] [Indexed: 11/22/2022] Open
Abstract
Tuberculosis (TB), including multidrug-resistant (MDR; i.e., resistant to at least rifampicin and isoniazid)/rifampicin-resistant (MDR/RR) TB, is the most important opportunistic infection among people living with HIV (PLHIV). In 2005, Rwanda launched the programmatic management of MDR/RR-TB. The shorter MDR/RR-TB treatment regimen (STR) has been implemented since 2014. We analyzed predictors of MDR/RR-TB mortality, including the effect of using the STR overall and among PLHIV. This retrospective study included data from patients diagnosed with RR-TB in Rwanda between July 2005 and December 2018. Multivariable logistic regression was used to assess predictors of mortality. Of 898 registered MDR/RR-TB patients, 861 (95.9%) were included in this analysis, of whom 360 (41.8%) were HIV coinfected. Overall, 86 (10%) patients died during MDR/RR-TB treatment. Mortality was higher among HIV-coinfected compared with HIV-negative TB patients (13.3% versus 7.6%). Among HIV-coinfected patients, patients aged ≥ 55 years (adjusted odds ratio = 5.89) and those with CD4 count ≤ 100 cells/mm3 (adjusted odds ratio = 3.77) had a higher likelihood of dying. Using either the standardized longer MDR/RR-TB treatment regimen or the STR was not correlated with mortality overall or among PLHIV. The STR was as effective as the long MDR/RR-TB regimen. In conclusion, older age and advanced HIV disease were strong predictors of MDR/RR-TB mortality. Therefore, special care for elderly and HIV-coinfected patients with ≤ 100 CD4 cells/mL might further reduce MDR/RR-TB mortality.
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Affiliation(s)
- Dominique Savio Habimana
- HIV, AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Jean Claude Semuto Ngabonziza
- National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Patrick Migambi
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Yves Mucyo-Habimana
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Grace Mutembayire
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Francine Byukusenge
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Innocent Habiyambere
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Eric Remera
- HIV, AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Placidie Mugwaneza
- HIV, AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Ivan Emil Mwikarago
- National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Innocent Turate
- Department of Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | | | - Tom Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Catherine Bouke de Jong
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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15
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The effects of MDR/RR-TB treatment on HIV disease: A systematic review of literature. PLoS One 2021; 16:e0248174. [PMID: 33667271 PMCID: PMC7935310 DOI: 10.1371/journal.pone.0248174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 02/19/2021] [Indexed: 11/19/2022] Open
Abstract
Background Multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB) and human immunodeficiency virus (HIV) co-infection are a deadly combination. While evidence on the effects of HIV co-infection on MDR/RR-TB treatment outcomes is well-documented, little published evidence describes the effects of MDR/RR-TB treatment on HIV disease. Methods We conducted a review of literature published prior to June 2020. We searched Pubmed, CINAHL, and EMBASE using variations of the terms “multidrug-resistant tuberculosis,” “HIV,” and either “CD4” or “viral load.” Two reviewers independently completed title and abstract screening, full-text screening, article evaluation, and data extraction. We also included five published articles evaluated as evidence by the World Health Organization (WHO) in preparation for the 2019 MDR/RR-TB treatment guideline update. Results A total of 459 references were returned, with 362 remaining after duplicate removal. Following article screening, six manuscripts were included. Articles reported CD4 count and/or viral load results for MDR/RR-TB and HIV co-infected patients during and/or after MDR/RR-TB treatment. The additional five references identified from the WHO guideline revision did not report HIV disease indicators after MDR/RR-TB initiation. Conclusion There is a paucity of evidence on HIV disease indicators following MDR/RR-TB treatment. Researchers should report longitudinal HIV disease indicators in co-infected patients in publications.
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16
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Edessa D, Sisay M, Dessie Y. Unfavorable outcomes to second-line tuberculosis therapy among HIV-infected versus HIV-uninfected patients in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2020; 15:e0237534. [PMID: 32797110 PMCID: PMC7428180 DOI: 10.1371/journal.pone.0237534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/28/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Drug resistance is a key obstacle to the global target set to end tuberculosis by 2030. Clinical complexities in drug-resistant tuberculosis and HIV-infection co-management could worsen outcomes of second-line anti-tuberculosis drugs. A comprehensive estimate for risks of unsuccessful outcomes to second-line tuberculosis therapy in HIV-infected versus HIV-uninfected patients is mandatory to address such aspects in segments of the target set. Therefore, this meta-analysis was aimed to estimate the pooled risk ratios of unfavorable outcomes to second-line tuberculosis therapy between HIV-infected and HIV-uninfected patients in sub-Saharan Africa. METHODS We conducted a literature search from PubMed/MEDLINE, EMBASE, SCOPUS and Google Scholar. We screened the retrieved records by titles and abstracts. Finally, we assessed eligibility and quality of full-text articles for the records retained by employing appraisal checklist of the Joanna Briggs Institute. We analyzed the data extracted from the included studies by using Review Manager Software, version 5.3 and presented our findings in forest and funnel plots. Protocol for this study was registered on PROSPERO (ID: CRD42020160473). RESULTS A total of 19 studies with 1,766 from 4,481 HIV-infected and 1,164 from 3,820 HIV-uninfected patients had unfavorable outcomes. The risk ratios we estimated between HIV-infected and HIV-uninfected drug-resistant tuberculosis patients were 1.18 (95% CI: 1.07-1.30; I2 = 48%; P = 0.01) for the overall unfavorable outcome; 1.50 (95% CI: 1.30-1.74) for death; 0.66 (95% CI: 0.38-1.13) for treatment failure; and 0.82 (95% CI: 0.74-0.92) for loss from treatment. Variable increased risks of unfavorable outcomes estimated for subgroups with significance in mixed-age patients (RR: 1.22; 95% CI: 1.10-1.36) and eastern region of sub-Saharan Africa (RR: 1.47; 95% CI: 1.23-1.75). CONCLUSIONS We found a higher risk of unfavorable treatment outcome in drug-resistant tuberculosis patients with death highly worsening in HIV-infected than in those HIV-uninfected patients. The risks for the unfavorable outcomes were significantly higher in mixed-age patients and in the eastern region of sub-Saharan Africa. Therefore, special strategies that reduce the risks of death should be discovered and implemented for HIV and drug-resistant tuberculosis co-infected patients on second-line tuberculosis therapy with optimal integration of the two programs in the eastern region of sub-Saharan Africa.
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Affiliation(s)
- Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Oromia, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Oromia, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Oromia, Ethiopia
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Bisson GP, Bastos M, Campbell JR, Bang D, Brust JC, Isaakidis P, Lange C, Menzies D, Migliori GB, Pape JW, Palmero D, Baghaei P, Tabarsi P, Viiklepp P, Vilbrun S, Walsh J, Marks SM. Mortality in adults with multidrug-resistant tuberculosis and HIV by antiretroviral therapy and tuberculosis drug use: an individual patient data meta-analysis. Lancet 2020; 396:402-411. [PMID: 32771107 PMCID: PMC8094110 DOI: 10.1016/s0140-6736(20)31316-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND HIV-infection is associated with increased mortality during multidrug-resistant tuberculosis treatment, but the extent to which the use of antiretroviral therapy (ART) and anti-tuberculosis medications modify this risk are unclear. Our objective was to evaluate how use of these treatments altered mortality risk in HIV-positive adults with multidrug-resistant tuberculosis. METHODS We did an individual patient data meta-analysis of adults 18 years or older with confirmed or presumed multidrug-resistant tuberculosis initiating tuberculosis treatment between 1993 and 2016. Data included ART use and anti-tuberculosis medications grouped according to WHO effectiveness categories. The primary analysis compared HIV-positive with HIV-negative patients in terms of death during multidrug-resistant tuberculosis treatment, excluding those lost to follow up, and was stratified by ART use. Analyses used logistic regression after exact matching on country World Bank income classification and drug resistance and propensity-score matching on age, sex, geographic site, year of multidrug-resistant tuberculosis treatment initiation, previous tuberculosis treatment, directly observed therapy, and acid-fast-bacilli smear-positivity to obtain adjusted odds ratios (aORs) and 95% CIs. Secondary analyses were conducted among those with HIV-infection. FINDINGS We included 11 920 multidrug-resistant tuberculosis patients. 2997 (25%) were HIV-positive and on ART, 886 (7%) were HIV-positive and not on ART, and 1749 (15%) had extensively drug-resistant tuberculosis. By use of HIV-negative patients as reference, the aOR of death was 2·4 (95% CI 2·0-2·9) for all patients with HIV-infection, 1·8 (1·5-2·2) for HIV-positive patients on ART, and 4·2 (3·0-5·9) for HIV-positive patients with no or unknown ART. Among patients with HIV, use of at least one WHO Group A drug and specific use of moxifloxacin, levofloxacin, bedaquiline, or linezolid were associated with significantly decreased odds of death. INTERPRETATION Use of ART and more effective anti-tuberculosis drugs is associated with lower odds of death among HIV-positive patients with multidrug-resistant tuberculosis. Access to these therapies should be urgently pursued. FUNDING American Thoracic Society, Canadian Institutes of Health Research, US Centers for Disease Control and Prevention, European Respiratory Society, Infectious Diseases Society of America.
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Affiliation(s)
- Gregory P Bisson
- Department of Medicine and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Mayara Bastos
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Jonathon R Campbell
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Didi Bang
- Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - James C Brust
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | | | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - Dick Menzies
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Giovanni B Migliori
- WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy
| | | | - Domingo Palmero
- División Neumotisiología, Hospital Muñiz, Buenos Aires, Argentina
| | - Parvaneh Baghaei
- Clinical Tuberculosis and Epidemiology Research Center National Research Institute for Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center National Research Institute for Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Piret Viiklepp
- National Institute of Health Development, Tallinn, Estonia
| | - Stalz Vilbrun
- Groupe Haitien d'Étude du Sarcome de Kaposi et des infections Opportunistes, Port-au-Prince, Haiti
| | - Jonathan Walsh
- Department of Medicine and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Suzanne M Marks
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Zhang L, Xing W, Zhou J, Zhang R, Cheng Y, Li J, Wang G, Liu S, Li Y. Characteristics of tuberculosis patients in the integrated tuberculosis control model in Chongqing, China: a retrospective study. BMC Infect Dis 2020; 20:576. [PMID: 32758169 PMCID: PMC7404911 DOI: 10.1186/s12879-020-05304-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 07/27/2020] [Indexed: 12/25/2022] Open
Abstract
Background China ranks second in the world in terms of numbers of tuberculosis (TB) cases and is one of the top three countries with the largest number of multidrug-resistant and rifampicin-resistant TB (MDR/RR-TB). It also has high mortality and low cure rates of human immunodeficiency virus (HIV)-positive TB patients. This study aimed to analyse, under the integrated TB control model, the characteristics of TB patients seeking healthcare in the largest designated TB hospital in Chongqing. Methods This was a retrospective study of TB registers in a health facility. Record data of 1827 TB patients who had attended the Chongqing Public Health Medical Center (CPHMC) from 1 January to 31 December 2018 were included. The Statistical Package for Social Science (SPSS 18.0; IBM Corporation, Armonk, NY, USA) was used to analyse the data. Counting data were compared using the chi-square test or Fisher’ s exact test. Among the results of the univariate analysis, the variables with statistical significance were included in the binomial stepwise logistic regression, with odds ratio and 95% confidence interval calculated. A two-tailed probability level of P < 0.05 was considered statistically significant. Results The majority of registered patients were men (1197), of Han ethnicity (1670), aged 21–60 years (1331), farmer/unemployed (1075), and living in county/district (1207). Approximately 24.9% of patients (455/1827) contracted DR-TB, 6% (110/1827) were co-infected with HIV, and 41.0% (749/1827) had drug-related hepatotoxicity. Among those patients, DR-TB was more likely to develop among farmers who received retreatment and had drug-related hepatotoxicity (P < 0.05). Women who received retreatment and lived in county/district were less likely to be HIV positive (P < 0.05). Compared with farmers, patients who were unemployed were more likely to be HIV positive, and those aged 21–60 years had a higher risk of being tested as HIV positive (P < 0.05). Conclusion Farmers who received retreatment and had drug-related hepatotoxicity are more susceptible to DR-TB; young unemployed men have a higher risk of contracting HIV-positive TB. The demographic and clinical characteristics of TB patients should be taken into consideration in DR-TB and HIV-positive TB screening in the future.
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Affiliation(s)
- Liwen Zhang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China.,Chongqing Public Health Medical Center (CPHMC), Chongqing, China
| | - Wei Xing
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Jiani Zhou
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Rui Zhang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Yong Cheng
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Jin Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Geng Wang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Shili Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China.
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Wilson JW, Nilsen DM, Marks SM. Multidrug-Resistant Tuberculosis in Patients with Human Immunodeficiency Virus. Management Considerations within High-resourced Settings. Ann Am Thorac Soc 2020; 17:16-23. [PMID: 31365831 PMCID: PMC6938532 DOI: 10.1513/annalsats.201902-185cme] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/30/2019] [Indexed: 12/15/2022] Open
Abstract
The management of multidrug-resistant tuberculosis (MDR TB) is notably complex among patients with human immunodeficiency virus (HIV). TB treatment recommendations typically include very little information specific to HIV and MDR TB, which often is derived from clinical trials conducted in low-resource settings. Mortality rates among patients with HIV and MDR TB remain high. We reviewed the published literature and recommendations to synthesize possible patient management approaches demonstrated to improve treatment outcomes in high-resourced countries for patients with MDR TB and HIV. Approaches to diagnostic testing, impact and timing of antiretroviral therapy on mortality, anti-MDR TB and antiretroviral drug interactions, and the potential role for short-course MDR TB therapy are examined. The combination of antiretroviral therapy with expanded TB drug therapy, along with the management of immune reconstitution inflammatory syndrome, other potential HIV-associated opportunistic diseases, and drug toxicities, necessitate an integrated multidisciplinary patient care approach using public health case management and provider expertise in drug-resistant TB and HIV management.
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Affiliation(s)
- John W. Wilson
- Division of Infectious Diseases, Mayo Clinic, 200 First Street, SW, Rochester MN 55905, Tel (507) 255-0596, Fax (507255-7767
| | - Diana M. Nilsen
- Bureau of TB Control, New York City Department of Health & Mental Hygiene, Gotham Center, CN#72B, 42-09 28th Street, Queens, NY 11101-4132
| | - Suzanne M. Marks
- Data Management, Statistics, and Evaluation Branch, Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Mailstop MS12-4, 1600 Clifton Road, NE, Atlanta, GA 30333
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Chaves Torres NM, Quijano Rodríguez JJ, Porras Andrade PS, Arriaga MB, Netto EM. Factors predictive of the success of tuberculosis treatment: A systematic review with meta-analysis. PLoS One 2019; 14:e0226507. [PMID: 31881023 PMCID: PMC6934297 DOI: 10.1371/journal.pone.0226507] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/27/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To produce pooled estimates of the global results of tuberculosis (TB) treatment and analyze the predictive factors of successful TB treatment. METHODS Studies published between 2014 and 2019 that reported the results of the treatment of pulmonary TB and the factors that influenced these results. The quality of the studies was evaluated according to the Newcastle-Ottawa quality assessment scale. A random effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) in February 2019 under number CRD42019121512. RESULTS A total of 151 studies met the criteria for inclusion in this review. The success rate for the treatment of drug-sensitive TB in adults was 80.1% (95% CI: 78.4-81.7). America had the lowest treatment success rate, 75.9% (95% CI: 73.8-77.9), and Oceania had the highest, 83.9% (95% CI: 75.2-91.0). In children, the success rate was 84.8% (95% CI: 77.7-90.7); in patients coinfected with HIV, it was 71.0% (95% CI: 63.7-77.8), in patients with multidrug-resistant TB, it was 58.4% (95% CI: 51.4-64.6), in patients with and extensively drug-resistant TB it was 27.1% (12.7-44.5). Patients with negative sputum smears two months after treatment were almost three times more likely to be successfully treated (OR 2.7; 1.5-4.8), whereas patients younger than 65 years (OR 2.0; 1.7-2.4), nondrinkers (OR 2.0; 1.6-2.4) and HIV-negative patients (OR 1.9; 1.6-2.5 3) were two times more likely to be successfully treated. CONCLUSION The success of TB treatment at the global level was good, but was still below the defined threshold of 85%. Factors such as age, sex, alcohol consumption, smoking, lack of sputum conversion at two months of treatment and HIV affected the success of TB treatment.
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Affiliation(s)
- Ninfa Marlen Chaves Torres
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Medicine, Nueva Granada Military University, Bogotá, D.C., Colombia
| | | | | | - María Belen Arriaga
- Gonzalo Moniz Institute, Gonzalo Cruz Foundation, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
| | - Eduardo Martins Netto
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
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Impact of ethnic disparities on the treatment outcomes of HIV-negative drug-resistant tuberculosis patients in Kuala Lumpur, Malaysia: A call for a culturally-sensitive community intervention approach. J Glob Antimicrob Resist 2019; 19:274-279. [PMID: 31100500 DOI: 10.1016/j.jgar.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 04/02/2019] [Accepted: 05/04/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Little is known about the treatment outcomes of HIV-negative drug-resistant tuberculosis (TB) patients in Malaysia. With respect to this issue, this study aimed to determine factors associated with unsuccessful treatment outcomes among drug-resistant TB patients at the Institute of Respiratory Medicine, Kuala Lumpur, Malaysia. METHODS This retrospective cohort study involved laboratory-confirmed drug-resistant TB patients from January 2009 to June 2013. Multiple logistic regression was used to model the outcome, which was subsequently defined according to the recent definition by the WHO. Data were analysed using IBM SPSS Statistics for Windows version 22.0. RESULTS Among the 403 patients who were analysed, 66.7% of them were found to have achieved successful outcomes (cured or completed treatment) while the remaining 33.3% had unsuccessful treatment outcomes (defaulted, treatment failure or died). Multivariable analysis showed that the type of resistance [polyresistant (aOR = 3.00, 95% CI 1.14-7.91), multidrug resistant (MDR) (aOR = 5.37, 95% CI 2.65-10.88)], ethnicity [Malay (aOR = 2.86, 95% CI 1.44-5.71), Indian (aOR = 3.04, 95% CI 1.20-7.70)], and treatment non-compliance (aOR = 26.93, 95% CI 14.47-50.10) were the independent risk factors for unsuccessful treatment outcomes among this group of patients. Notably, the odds of unsuccessful treatment outcome was also amplified among Malay MDR-TB patients in this study (aOR = 13.44, 95% CI 1.99-90.58). CONCLUSION In order to achieve better treatment outcomes for TB, effective behavioural intervention and thorough investigation on ethnic disparities in TB treatment are needed to promote good compliance.
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Magis-Escurra C, Carvalho ACC, Kritski AL, Girardi E. Tuberculosis and comorbidities. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10022017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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