Treatment outcomes in multidrug resistant tuberculosis-human immunodeficiency virus Co-infected patients on anti-retroviral therapy at Sizwe Tropical Disease Hospital Johannesburg, South Africa

Abstract

BackgroundMultidrug resistant-tuberculosis (MDR-TB) is a threat to global tuberculosis control which is worsened by human immune-deficiency virus (HIV) co-infection. There is however paucity of data on the effects of antiretroviral treatment (ART) before or after starting MDR-TB treatment. This study determined predictors of mortality and treatment failure among HIV co-infected MDR-TB patients on ART.MethodsA retrospective medical record review of 1200 HIV co-infected MDR-TB patients admitted at Sizwe Tropical Disease Hospital, Johannesburg from 2007 to 2010 was performed. Chi-square test was used to determine treatment outcomes in HIV co-infected MDR-TB patients on ART. Multivariable logistic regression and Poisson models were used to determine predictors of mortality and treatment failure respectively.ResultsMortality was higher (21.8 % vs. 15.4 %) among patients who started ART before initiating MDR-TB treatment compared with patients initiated on ART after commencing MDR-TB treatment (p = 0.013). Factors significantly associated with mortality included: the use of ART before starting MDR-TB treatment (OR 1.65, 95 % CI 1.02–2.73), severely-underweight (OR 3.71, 95 % CI 1.89–7.29) and underweight (OR 2.35, 95 % CI 1.30–4.26), cavities on chest x-rays at baseline (OR 1.76, 95 % CI 1.08–2.94), presence of other opportunistic infections (OR 1.80, 95 % CI 1.10–2.94) and presence of other co-morbidities (OR 2.26, 95 % CI 1.20–4.21). Factors predicting failure were severe anaemia (IRR (OR 4.72, 95 % CI 1.47–15), other co-morbidities (OR 2.39, 95 % CI 1.05–5.43) and modified individualised regimen at baseline (OR 2.15, 95 % CI 0.98–4.71).ConclusionsHigh mortality among patients already on ART before initiating MDR-TB treatment is a worrisome development. Management of adverse-events, opportunistic infections and co-morbidities in these patients is important if the protective benefits of being on ART are to be maximized. There is the need to intensify intervention programmes targeted at early identification of MDR-TB, treatment initiation, drug monitoring and increasing adherence among HIV co-infected MDR-TB patients.

Whole genome sequencing of Mycobacterium tuberculosis isolates and clinical outcomes of patients treated for multidrug-resistant tuberculosis in Tanzania

“…However, this is lower than that reported by Dheda et al, [46] and Milanov et al, [47] in South Africa and Bulgaria who both documented over 50% unfavourable treatment outcomes. Previous findings have argued that severe malnutrition (BMI < 16 kg/m2), HIV coinfection, previous history of anti-TB therapy and drug adverse events can predict poor treatment outcomes [47,48]. In this study, 29.9% of the study participants had low BMI and 23% were infected with HIV but had no effects on MDR-TB treatment outcomes.…”

Unfavourable outcomes among patients with MDR-TB on the standard 24-month regimen in Maharashtra, India

“…Poor treatment outcomes among a cohort of HIV co-infected patients have been described in studies from Mumbai, India, and Johannesburg, South Africa. 11,12 Malnutrition has also been associated with unfavourable treatment outcomes. 13,14 Timely initiation of antiretroviral therapy (ART) or of continuation of ART for patients already on treatment, through effective TB-HIV linkage, nutritional supplementation for patients in low weight groups and treatment adherence support has helped in reducing deaths and LTFU, ensuring a treatment success of 79%.…”

Treatment outcomes and antiretroviral uptake in Multidrug-Resistant Tuberculosis and HIV coinfected Patients in Sub Saharan Africa. A Systematic Review and Meta-Analysis

“…Of these, 3368 were MDR-TB and HIV co-infected. Study duration varied from one year [13] to over eight years [16], with majority (n = 4) of the studies conducted over periods of three to four years [14,[22][23][24]. Six studies were conducted in South Africa [14,16,[22][23][24][25], one in Lesotho [13], one in Botswana [17] and one in Ethiopia [15].…”

“…Study duration varied from one year [13] to over eight years [16], with majority (n = 4) of the studies conducted over periods of three to four years [14,[22][23][24]. Six studies were conducted in South Africa [14,16,[22][23][24][25], one in Lesotho [13], one in Botswana [17] and one in Ethiopia [15]. Five studies were retrospective cohort studies [13][14][15][16]24], with two prospective cohort studies [17,22], one case control study [23] and one randomized controlled trial (RCT) [25].…”

“…Research on treatment outcomes in SSA has assessed: the effect of ART initiation time on treatment outcomes [13,14], treatment success and survival in MDR-TB and HIV co-infected cohorts [15][16][17] and predictors of outcomes [14]. Previous reviews have addressed the risk factors of HIV and MDR-TB in SSA [7,18].…”