M Bhering1, R Duarte2, A Kritski3. 1. Academic Tuberculosis Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil, Professor Hélio Fraga Reference Centre, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil. 2. EPIUnit, Public Health Institute, University of Porto, Porto, Portugal, Public Health Science and Medical Education Department, School of Medicine, University of Porto, Porto, Portugal. 3. Academic Tuberculosis Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Abstract
BACKGROUND: Brazil ranks 14th worldwide in the number of TB cases and 19th in terms of TB-HIV co-infected cases. This study aims at identifying clinical and demographic factors associated with unsuccessful treatment outcomes (loss to follow-up, treatment failure and death) of HIV-positive patients with multidrug-resistant TB (MDR-TB) in Rio de Janeiro State, Brazil. METHODS: This was a retrospective cohort study of MDR-TB cases notified from 2000 to 2016 in RJ. Cox proportional hazard regression models were used to assess risk factors associated with unsuccessful treatment in HIV-positive patients with MDR-TB. RESULTS: Among 2,269 patients, 156 (6.9%) were HIV-positive and had a higher proportion of unsuccessful treatment outcomes (52.6%) than HIV-negative cases (43.7%). All HIV-positive cases with extensively drug-resistant TB (XDR-TB) had unsuccessful treatment outcomes. Multivariate analysis shows that previous MDR-TB treatment (HR 1.97, 95% CI 1.22-3.18) and illicit drugs use (HR 1.68, 95% CI 1.01-2.78) were associated with a greater hazard of unsuccessful treatment outcomes, while 6-month culture conversion (HR 0.48, 95% CI 0.27-0.84) and use of antiretroviral therapy (ART) (HR 0.51, 95% CI 0.32-0.80) were predictors of reduced risk. CONCLUSIONS: Unsuccessful treatment was higher among HIV patients with MDR-TB than among HIV-negative patients. Prompt initiation of ART and effective interventions are necessary to improve treatment adherence and prevent retreatment cases.
BACKGROUND: Brazil ranks 14th worldwide in the number of TB cases and 19th in terms of TB-HIV co-infected cases. This study aims at identifying clinical and demographic factors associated with unsuccessful treatment outcomes (loss to follow-up, treatment failure and death) of HIV-positive patients with multidrug-resistant TB (MDR-TB) in Rio de Janeiro State, Brazil. METHODS: This was a retrospective cohort study of MDR-TB cases notified from 2000 to 2016 in RJ. Cox proportional hazard regression models were used to assess risk factors associated with unsuccessful treatment in HIV-positive patients with MDR-TB. RESULTS: Among 2,269 patients, 156 (6.9%) were HIV-positive and had a higher proportion of unsuccessful treatment outcomes (52.6%) than HIV-negative cases (43.7%). All HIV-positive cases with extensively drug-resistant TB (XDR-TB) had unsuccessful treatment outcomes. Multivariate analysis shows that previous MDR-TB treatment (HR 1.97, 95% CI 1.22-3.18) and illicit drugs use (HR 1.68, 95% CI 1.01-2.78) were associated with a greater hazard of unsuccessful treatment outcomes, while 6-month culture conversion (HR 0.48, 95% CI 0.27-0.84) and use of antiretroviral therapy (ART) (HR 0.51, 95% CI 0.32-0.80) were predictors of reduced risk. CONCLUSIONS: Unsuccessful treatment was higher among HIV patients with MDR-TB than among HIV-negative patients. Prompt initiation of ART and effective interventions are necessary to improve treatment adherence and prevent retreatment cases.
Authors: Hanalise V Huff; Paloma M Carcamo; Monica M Diaz; Jamie L Conklin; Justina Salvatierra; Rocio Aponte; Patricia J Garcia Journal: Int J Environ Res Public Health Date: 2022-06-12 Impact factor: 4.614
Authors: Chan Mi Lee; Eunyoung Lee; Ji Hwan Bang; Sang-Won Park; Wan Beom Park; Myoung-Don Oh; Nam Joong Kim Journal: Infect Chemother Date: 2021-12-07