1. Outcomes of HIV-infected versus HIV-non-infected patients treated for drug-resistance tuberculosis: Multicenter cohort study
- Author
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Alex Telnov, Atadjan Khamraev, Shazina Khurkhumal, Philipp du Cros, Kamene Kimenye, Mathieu Bastard, Elisabeth Sanchez-Padilla, Francis Varaine, Cathy Hewison, Nargiza Parpieva, Mirzagaleg Tillyashaykov, Maryline Bonnet, Santiago Fadul Perez, Armen Hayrapetyan, and Themba Dlamini
- Subjects
RNA viruses ,Bacterial Diseases ,Male ,0301 basic medicine ,Epidemiology ,Antitubercular Agents ,lcsh:Medicine ,HIV Infections ,Pathology and Laboratory Medicine ,0302 clinical medicine ,Immunodeficiency Viruses ,Risk Factors ,Tuberculosis, Multidrug-Resistant ,Case fatality rate ,Medicine and Health Sciences ,Medicine ,Public and Occupational Health ,030212 general & internal medicine ,lcsh:Science ,Multidisciplinary ,Pharmaceutics ,Coinfection ,Multi-Drug-Resistant Tuberculosis ,Mortality rate ,Multi-drug-resistant tuberculosis ,virus diseases ,Middle Aged ,Vaccination and Immunization ,Infectious Diseases ,Treatment Outcome ,Medical Microbiology ,HIV epidemiology ,Viral Pathogens ,Viruses ,Asia, Central ,Female ,Pathogens ,Research Article ,Cohort study ,Adult ,medicine.medical_specialty ,Tuberculosis ,Death Rates ,Immunology ,030106 microbiology ,Antiretroviral Therapy ,Colombia ,Microbiology ,03 medical and health sciences ,Pharmacotherapy ,Population Metrics ,Drug Therapy ,Antiviral Therapy ,Microbial Control ,Internal medicine ,Retroviruses ,Humans ,Microbial Pathogens ,Retrospective Studies ,Pharmacology ,Population Biology ,business.industry ,lcsh:R ,Lentivirus ,Organisms ,Biology and Life Sciences ,HIV ,Retrospective cohort study ,Tropical Diseases ,medicine.disease ,Survival Analysis ,Transcaucasia ,Regimen ,Antibiotic Resistance ,Africa ,lcsh:Q ,Antimicrobial Resistance ,Preventive Medicine ,business ,Follow-Up Studies - Abstract
Background The emergence of resistance to anti-tuberculosis (DR-TB) drugs and the HIV epidemic represent a serious threat for reducing the global burden of TB. Although data on HIV-negative DR-TB treatment outcomes are well published, few data on DR-TB outcomes among HIV co-infected people is available despite the great public health importance. Methods We retrospectively reported and compared the DR-TB treatment outcomes of HIV-positive and HIV-negative patients treated with an individualized regimen based on WHO guidelines in seven countries: Abkhazia, Armenia, Colombia, Kenya, Kyrgyzstan, Swaziland and Uzbekistan. Results Of the 1,369 patients started DRTB treatment, 809 (59.1%) were multi-drug resistant (MDR-TB) and 418 (30.5%) were HIV-positive. HIV-positive patients were mainly from African countries (90.1%) while HIV-negative originated from Former Soviet Union (FSU) countries. Despite a higher case fatality rate (19.0% vs 9.4%), HIV-positive MDR-TB patients had a 10% higher success rate than HIV-negative patients (64.0% vs 53.2%, p = 0.007). No difference in treatment success was found among polydrug-resistant (PDR-TB) patients. Overall, lost to follow-up rate was much higher among HIV-negative (22.0% vs. 8.4%). Older age and not receiving ART were the only factors associated with unfavorable treatment outcome among HIV-positive patients. Conclusions As already known for HIV-negative patients, success rate of DR-TB HIV-positive patients remains low and requires more effective DR-TB regimen using new drugs also suitable to HIV-infected patients on ART. The study also confirms the need of ART introduction in HIV co-infected patients.
- Published
- 2018