Risk factors for poor treatment outcomes of 2266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study

Abstract

Background: Multidrug resistant tuberculosis (MDR-TB) remains a serious public health problem with poor treatment outcomes. Predictors of poor outcomes vary in different regions. Vietnam is among the top 30 high burden of MDR-TB countries. We describe demographic characteristics and identify risk factors for poor outcome among patients with MDR-TB in Ho Chi Minh City (HCMC), the most populous city in Vietnam. Methods: This retrospective study included 2266 patients who initiated MDR-TB treatment between 2011 and 2015 in HCMC. Treatment outcomes were available for 2240 patients. Data was collected from standardized paper-based treatment cards and electronic records. A Kruskal Wallis test was used to assess changes in median age and body mass index (BMI) over time, and a Wilcoxon test was used to compare the median BMI of patients with and without diabetes mellitus. Chi squared test was used to compare categorical variables. Multivariate logistic regression with multiple imputation for missing data was used to identify risk factors for poor outcomes. Statistical analysis was performed using R program. Results: Among 2266 eligible cases, 60.2% had failed on a category I or II treatment regimen, 57.7% were underweight, 30.2% had diabetes mellitus and 9.6% were HIV positive. The notification rate increased 24.7% from 2011 to 2015. The treatment success rate was 73.3%. Risk factors for poor treatment outcome included HIV co-infection (adjusted odds ratio (aOR): 2.94), advanced age (aOR: 1.45 for every increase of 5 years for patients 60 years or older), having history of MDR-TB treatment (aOR: 5.53), sputum smear grade scanty or 1+ (aOR: 1.47), smear grade 2+ or 3+ (aOR: 2.06), low BMI (aOR: 0.83 for every increase of 1 kg/m2 of BMI for patients with BMI < 21). Conclusion: The number of patients diagnosed with MDR-TB in HCMC increased by almost a quarter between 2011 and 2015. Patients with HIV, high smear grade, malnutrition or a history of previous MDR-TB treatment are at greatest risk of poor treatment outcome.

Factores de éxito del tratamiento de la tuberculosis multidrogorresistente relacionados con el paciente y el personal sanitario en Colombia

“…Esto puede estar relacionado con la calidad de la atención que se ofrece ( 28 ) o con algunos determinantes sociales de la salud, pues los pacientes que pertenecen al régimen contributivo tienen mejores condiciones socioeconómicas que los del régimen subsidiado ( 27 , 29 ). Por su parte, la infección por el VIH es una comorbilidad asociada con el desarrollo de la TB y es un reconocido factor de riesgo de tratamiento no exitoso en los casos de TB-MDR ( 30 , 31 ).…”

Patient- and provider-related factors in the success of multidrug-resistant tuberculosis treatment in Colombia

“…This difference may be related to the quality of the care offered ( 28 ) or to social determinants of health, since the patients insured under the contributory regime had more socioeconomic advantages than those in the subsidized system ( 27 , 29 ). Another variable, HIV infection, is a comorbidity associated with the development of TB and a recognized risk factor for unsuccessful treatment in cases of MDR-TB ( 30 , 31 ).…”

Unfavorable outcomes to second-line tuberculosis therapy among HIV-infected versus HIV-uninfected patients in sub-Saharan Africa: A systematic review and meta-analysis

“…Another study also explained that the risk of unfavorable outcome was 1.14 times higher among HIV-infected patients than in those HIV-uninfected [ 45 ]. Again, for several studies with different sample sizes but assessed treatment outcomes to second-line TB therapy, the risks of unfavorable outcome were 1.5 (in a study with 439 participants) [ 46 ]; 2.2 (in a study with 2,185 participants) [ 47 ]; 2.94 (in a study with 2,266 participants) [ 11 ]; 3.3 (in a study with 3,729 participants) [ 48 ]; 3.44 (in a study with 1,809 participants) [ 49 ]; 7.14 (in a study with 302 participants) [ 50 ]; 10.07 (in a study with 360 participants) [ 51 ]; 10.16 (in a study with 235 participants) [ 52 ]; and 41 (in 51 cases as participants) [ 53 ] times higher among HIV-infected patients than those HIV-uninfected ones. Alternatively, the likelihood of success for second-line anti-tuberculosis treatment was 2.3 times higher among HIV-uninfected patients than the HIV-infected ones [ 54 ].…”

“…The appropriate regimen involving four or more drugs commonly combined from the core second-line medicines to treat the DR-TB includes group A (levofloxacin, moxifloxacin, gatifloxacin), group B (amikacin, capreomycin, kanamycin, streptomycin), and group C (ethionamide/prothionamide, cycloserine/terizidone, linezolid, clofazimine) plus one drug or none from the add-on agents from group D (pyrazinamide, ethambutol, high-dose isoniazid, delamanid, bedaquiline, p-aminosalicylic acid, imipenem–cilastatin, meropenem, and amoxicillin-clavulanate) [ 10 ]. However, the presence of HIV-coinfection influences the successful outcomes to treatment with the second-line anti-tuberculosis medicines; for that, both infections are commonly indicated as cursed duets that exist together and affect the outcomes of each other [ 11 , 12 ].…”