Outcomes of HIV-infected versus HIV-non-infected patients treated for drug-resistance tuberculosis: Multicenter cohort study

<div><p>Background</p><p>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.</p><p>Methods</p><p>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.</p><p>Results</p><p>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.</p><p>Conclusions</p><p>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.</p></div

Treatment outcomes of DRTB patients stratified by DST profiles and HIV status.

<p>Treatment outcomes of DRTB patients stratified by DST profiles and HIV status.</p

Kaplan-Meier estimates of mortality (a) and lost to follow-up (b) stratified by HIV status.

<p>Kaplan-Meier estimates of mortality (a) and lost to follow-up (b) stratified by HIV status.</p

Characteristics of DRTB patients at treatment start stratified by HIV status.

<p>Characteristics of DRTB patients at treatment start stratified by HIV status.</p

Risk factors of unsuccessful (failure, death or lost to follow-up) DR-TB treatment outcome among patients HIV co-infected (N = 418).

<p>Risk factors of unsuccessful (failure, death or lost to follow-up) DR-TB treatment outcome among patients HIV co-infected (N = 418).</p

Alcohol drinking twice per week or more in members of households with TB compared to those without TB.

Alcohol drinking twice per week or more in members of households with TB compared to those without TB.</p

Sensitivity analysis-impact of misclassification of diabetes on its association with members of households with TB.

Sensitivity analysis-impact of misclassification of diabetes on its association with members of households with TB.</p

Diabetes in members of households with TB compared to those without TB.

Diabetes in members of households with TB compared to those without TB.</p

Sensitivity analysis- prevalence of NCD/NCD risk factors in members of households with TB compared to those without TB.

Sensitivity analysis- prevalence of NCD/NCD risk factors in members of households with TB compared to those without TB.</p

Association between BMI of people with TB and the same in their household members.

Association between BMI of people with TB and the same in their household members.</p