Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9,153 patients.

Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB

Treatment Outcomes of Patients With Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis According to Drug Susceptibility Testing to First- and Second-line Drugs: An Individual Patient Data Meta-analysis

The clinical validity of drug susceptibility testing (DST) for pyrazinamide, ethambutol, and second-line antituberculosis drugs is uncertain. In an individual patient data meta-analysis of 8955 patients with confirmed multidrug-resistant tuberculosis, DST results for these drugs were associated with treatment outcome

Treatment Outcomes for Patients with Extensively Drug-Resistant Tuberculosis, KwaZulu-Natal and Eastern Cape Provinces, South Africa

We analyzed data for a retrospective cohort of patients treated for extensively drug-resistant tuberculosis in 2 provinces in South Africa and compared predictors of treatment outcome in HIV-positive patients who received or had not received antiretroviral drugs with those for HIV-negative patients. Overall, 220 (62.0%) of 355 patients were HIV positive. After 2 years, 34 (10.3%) of 330 patients with a known HIV status and known outcome had a favorable outcome. Multivariate analysis showed that predictors of favorable outcome were negative results for acid-fast bacilli by sputum microscopy at start of treatment and weight >50 kg. HIV-positive patients were more likely to have an unfavorable outcome. The strongest predictor of unfavorable outcome was weight <50 kg. Overall outcomes were poor. HIV status was not a predictor of favorable outcome, but HIV-positive patients were more likely to have an unfavorable outcome. These results underscore the need for timely and adequate treatment for tuberculosis and HIV infection

Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Treatment among Co-Infected Persons in South Africa, 2008-2010.

BACKGROUND:Adherence to tuberculosis (TB) treatment and antiretroviral therapy (ART) reduces morbidity and mortality among persons co-infected with TB/HIV. We measured adherence and determined factors associated with non-adherence to concurrent TB treatment and ART among co-infected persons in two provinces in South Africa. METHODS:A convenience sample of 35 clinics providing integrated TB/HIV care was included due to financial and logistic considerations. Retrospective chart reviews were conducted among persons who received concurrent TB treatment and ART and who had a TB treatment outcome recorded during 1 January 2008-31 December 2010. Adherence to concurrent TB and HIV treatment was defined as: (1) taking ≥80% of TB prescribed doses by directly observed therapy (DOT) as noted in the patient card; and (2) taking >90% ART doses as documented in the ART medical record during the concurrent treatment period (period of time when the patient was prescribed both TB treatment and ART). Risk ratios (RRs) and 95% confidence intervals (CIs) were used to identify factors associated with non-adherence. RESULTS:Of the 1,252 persons receiving concurrent treatment, 138 (11.0%) were not adherent. Non-adherent persons were more likely to have extrapulmonary TB (RR: 1.71, 95% CI: 1.12 to 2.60) and had not disclosed their HIV status (RR: 1.96, 95% CI: 1.96 to 3.76). CONCLUSIONS:The majority of persons with TB/HIV were adherent to concurrent treatment. Close monitoring and support of persons with extrapulmonary TB and for persons who have not disclosed their HIV status may further improve adherence to concurrent TB and antiretroviral treatment

Study Population Included in TB/HIV Concurrent Treatment Analysis, 2008–2010.

<p>Study Population Included in TB/HIV Concurrent Treatment Analysis, 2008–2010.</p

Multivariate analysis of the relationship between characteristics of persons receiving concurrent TB/HIV treatment in selected THAT’SIT clinics and non-adherence to concurrent TB and HIV treatment (N = 1252).

<p>TB = tuberculosis, HIV = human immunodeficiency virus.</p

Bivariate relationship between characteristics of persons receiving concurrent TB/HIV treatment in selected THAT’SIT clinics and adherence to treatment (N = 1,252).

<p>BMI = body mass index; TB = tuberculosis; HRZE = isoniazid, rifampin, pyrazinamide, ethambutol; HRZES = isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin; DOT = directly observed therapy; WHO = World Health Organization; HIV = human immunodeficiency virus; ARV = antiretroviral; D4T/3TC/EFV = stavudine, lamivudine, efavirenz; D4T/3TC/NVP = stavudine, lamivudine, nevirapine.</p

Demographic, clinical, and social characteristics of patients receiving concurrent TB/HIV treatment in selected THAT’SIT clinics, South Africa, 2008–2010 (N = 1,252).

<p>BMI = body mass index; TB = tuberculosis; IRZE = isoniazid, rifampin, pyrazinamide, ethambutol; DOT = directly observed therapy; WHO = World Health Organization; HIV = human immunodeficiency virus; ARV = antiretroviral; D4T/3TC/EFV = stavudine, lamivudine, efavirenz; D4T/3TC/NVP = stavudine, lamivudine, nevirapine.</p