Samuel Om Manda1, Lieketseng J Masenyetse2, Joey L Lancaster3, Martie L van der Walt3. 1. Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa ; Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa. 2. Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa. 3. TB Epidemiology and Intervention Research Unit, South African Medical Research Council, Pretoria, South Africa.
Abstract
BACKGROUND: Even though highly effective drugs are available in South Africa, multidrug resistant tuberculosis (MDR-TB) patients with HIV infection have higher mortality compared to HIV-uninfected MDR-TB patients. This trend has been observed in similar countries with high HIV prevalence. This study sought to determine excess mortality attributable to HIV among MDR-TB patients in South Africa using relative survival methods. METHODS: Data available were from a cohort of 2079 MDR-TB patients enrolled in a Standardized Programmatic Management of MDR-TB from 2000 to 2004 in South Africa. A Poisson-based model adjusted for age, gender, year of diagnosis, TB history, and resistance to ethambutol, anti-TB injectable drugs and fluoroquinolones antibiotics was constructed to assess the excess mortality among HIV co-infected MDR-TB patients. Excess hazard ratios (EHRs) were used to describe the effect of the predictors on net mortality, controlling for the general mortality in the South African population. RESULTS: Death was recorded on 1619 patients, of whom 367 (22.7%) had died within 2 years. Out of the 1413 patients that tested for HIV infection, 554 (39.2%) tested positive. Excess mortality was higher in HIV infected, compared to HIV uninfected, MDR-TB patients (adjusted excess hazard ratio, 5.6 [95% CI, 3.2-9.7]); in patients whose TB isolates' resistance to ethambutol and kanamycin was unknown (3.7 [2.1-6.2] and 4.87 [1.9-13.3], respectively) vs. known. There were no differences in excess mortality between age and gender of the patient, year of diagnosis and TB history. CONCLUSION: Adjusting for some important predictors, MDR-TB patients with HIV infection experienced higher excess mortality compared to HIV-uninfected MDR-TB patients, after accounting for the general mortality in South Africa. An appropriate, though complex method has produced predictor effect estimates similar to those obtained from classical methods. Thus, the use of relative survival methods should be encouraged in the analysis of causespecific mortality, when ascertainment of cause of death is inaccurate or unknown.
BACKGROUND: Even though highly effective drugs are available in South Africa, multidrug resistant tuberculosis (MDR-TB) patients with HIV infection have higher mortality compared to HIV-uninfected MDR-TBpatients. This trend has been observed in similar countries with high HIV prevalence. This study sought to determine excess mortality attributable to HIV among MDR-TBpatients in South Africa using relative survival methods. METHODS: Data available were from a cohort of 2079 MDR-TBpatients enrolled in a Standardized Programmatic Management of MDR-TB from 2000 to 2004 in South Africa. A Poisson-based model adjusted for age, gender, year of diagnosis, TB history, and resistance to ethambutol, anti-TB injectable drugs and fluoroquinolones antibiotics was constructed to assess the excess mortality among HIV co-infected MDR-TBpatients. Excess hazard ratios (EHRs) were used to describe the effect of the predictors on net mortality, controlling for the general mortality in the South African population. RESULTS:Death was recorded on 1619 patients, of whom 367 (22.7%) had died within 2 years. Out of the 1413 patients that tested for HIV infection, 554 (39.2%) tested positive. Excess mortality was higher in HIV infected, compared to HIV uninfected, MDR-TBpatients (adjusted excess hazard ratio, 5.6 [95% CI, 3.2-9.7]); in patients whose TB isolates' resistance to ethambutol and kanamycin was unknown (3.7 [2.1-6.2] and 4.87 [1.9-13.3], respectively) vs. known. There were no differences in excess mortality between age and gender of the patient, year of diagnosis and TB history. CONCLUSION: Adjusting for some important predictors, MDR-TBpatients with HIV infection experienced higher excess mortality compared to HIV-uninfected MDR-TBpatients, after accounting for the general mortality in South Africa. An appropriate, though complex method has produced predictor effect estimates similar to those obtained from classical methods. Thus, the use of relative survival methods should be encouraged in the analysis of causespecific mortality, when ascertainment of cause of death is inaccurate or unknown.
Entities:
Keywords:
HIV; Relative mortality; South Africa; Tuberculosis
Authors: Evan W Orenstein; Sanjay Basu; N Sarita Shah; Jason R Andrews; Gerald H Friedland; Anthony P Moll; Neel R Gandhi; Alison P Galvani Journal: Lancet Infect Dis Date: 2009-03 Impact factor: 25.071
Authors: Jason E Farley; Malathi Ram; William Pan; Stacie Waldman; Gail H Cassell; Richard E Chaisson; Karin Weyer; Joey Lancaster; Martie Van der Walt Journal: PLoS One Date: 2011-07-22 Impact factor: 3.240
Authors: Max R O'Donnell; Alexander Pym; Paras Jain; Vanisha Munsamy; Allison Wolf; Farina Karim; William R Jacobs; Michelle H Larsen Journal: J Clin Microbiol Date: 2015-04-29 Impact factor: 5.948
Authors: Muhammad Osman; James A Seddon; Rory Dunbar; Heather R Draper; Carl Lombard; Nulda Beyers Journal: BMC Public Health Date: 2015-06-18 Impact factor: 3.295