Treatment Outcomes in Multidrug Resistant Tuberculosis-Human Immunodeficiency Virus Co-Infected Patients on Anti-Retroviral Therapy at Sizwe Tropical Disease Hospital Johannesburg, South Africa

Multidrug 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.

A 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.

Mortality 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, severely-underweight and underweight, cavities on chest x-rays at baseline, presence of other opportunistic infectionsand presence of other co-morbidities. Factors predicting failure were severe anaemia, other co-morbidities and modified individualised regimen at baseline.

High 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.

Full article at: http://goo.gl/xgL37Z

By: Teye Umanah¹, Jabulani Ncayiyana¹², Xavier Padanilam³ and Peter S. Nyasulu^14*

¹Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

²Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

³Sizwe Tropical Disease Hospital, Gauteng Department of Health, Sandringham, Johannesburg

⁴Department of Public Health, School of Health Sciences, Monash University, 144 Peter Road, Johannesburg, Rumsuig, South Africa

   

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