Converging risk factors but no association between HIV infection and multidrug-resistant tuberculosis in Kazakhstan

S, van den Hof; Tursynbayeva, Aigul; Abildaev, T.; Adenov, M.; Pak, Soojong; Bekembayeva, Gulbadan; Ismailov, Shakhimurat

doi:10.5588/ijtld.12.0703

Cited by 18 publications

(9 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Second, where effective treatment is provided, outcomes of TB infection among those infected with HIV, at least where immunosuppression is mild or ART is also provided, are as good as in HIV-negative prisoners [92], consistent with other evidence that treatment for drugsensitive TB is effective in the early stages of immunodeficiency [93]. Third, in the presence of sensitivity testing and continuity of treatment, those with HIV infection are at no greater risk of developing MDR-TB, beyond their risk for TB in general [94,95], and, in one Russian study, prisoners with coinfection were significantly less likely to develop resistance, although the explanation was unclear [96].…”

Section: Prevention and Treatmentsupporting

confidence: 77%

Prisoners co‐infected with tuberculosis and HIV: a systematic review

Edge

King

Dolan

et al. 2016

Journal of the International AIDS Society

View full text Add to dashboard Cite

IntroductionAlmost from the beginning of the HIV epidemic in 1981, an association with tuberculosis (TB) was recognized. This association between HIV and TB co-infection has been particularly evident amongst prisoners. However, despite this, few studies of TB in prisons have stratified results by HIV status. Given the high prevalence of HIV-positive persons and TB-infected persons in prisons and the documented risk of TB in those infected with HIV, it is of interest to determine how co-infection varies amongst prison populations worldwide. For this reason we have undertaken a systematic review of studies of co-infected prisoners to determine the incidence and/or prevalence of HIV/TB co-infection in prisons, as well as outcomes in this group, measured as treatment success or death.MethodsA literature search was undertaken using the online databases PubMed, Embase, IBSS, Scopus, Web of Science, Global Health and CINAHL Plus. No restrictions were set on language or publication date for article retrieval, with articles included if indexed up to 18 October 2015. A total of 1975 non-duplicate papers were identified. For treatment and outcome data all eligible papers were appraised for inclusion; for incidence/prevalence estimates papers published prior to 2000 were excluded from full text review. After full text appraisal, 46 papers were selected for inclusion in the review, 41 for incidence/prevalence estimates and nine for outcomes data, with four papers providing evidence for both outcomes and prevalence/incidence.ResultsVery few studies estimated the incidence of TB in HIV positive prisoners, with most simply reporting prevalence of co-infection. Co-infection is rarely explicitly measured, with studies simply reporting HIV status in prisoners with TB, or a cross-sectional survey of TB prevalence amongst prisoners with HIV. Estimates of co-infection prevalence ranged from 2.4 to 73.1% and relative risks for one, given the other, ranged from 2.0 to 10.75, although some studies reported no significant association between HIV and TB. Few studies provided a comparison with the risk of co-infection in the general population.ConclusionsPrisoners infected with HIV are at high risk of developing TB. However, the magnitude of risk varies between different prisons and countries. There is little evidence on treatment outcomes in co-infected prisoners, and the existing evidence is conflicting in regards to HIV status influence on prisoner treatment outcomes.PROSPERO Number: CRD42016034068

show abstract

Section: Prevention and Treatmentsupporting

confidence: 77%

Prisoners co‐infected with tuberculosis and HIV: a systematic review

Edge

King

Dolan

et al. 2016

Journal of the International AIDS Society

View full text Add to dashboard Cite

show abstract

“…Further, this pilot found high proportions of RR-TB among (former) prisoners and PLWHA suspected of TB, which was in line with a recent study showing largely overlapping risk factors for HIV and MDR-TB among TB patients in Kazakhstan. [ 17 , 18 ] Increasing referrals from penitentiary and HIV centers to TB centers could maximize the yield of Xpert with regard to RR-TB case detection and treatment. Another option would be to expand Xpert testing to all presumptive TB cases regardless of their risk group, which is justifiable given the high prevalence of MDR-TB among new TB patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of Introducing Xpert MTB/RIF to Test and Treat Individuals at Risk of Multidrug-Resistant Tuberculosis in Kazakhstan: A Prospective Cohort Study

Kampen

Tursynbayeva²,

Koptleuova³

et al. 2015

PLoS ONE

View full text Add to dashboard Cite

BackgroundXpert MTB/RIF (Xpert) was piloted in Kazakhstan to detect tuberculosis (TB) and rifampicin resistance (RR-)TB among individuals at risk of multidrug-resistant (MDR-) TB. This study assessed the performance of Xpert compared to conventional diagnostic methods, RR-TB case detection among various risk groups, treatment initiation and time to diagnosis and treatment.MethodsEligible individuals were tested with Xpert, smear microscopy, culture and drug-susceptibility testing (DST) at the national TB reference laboratory and three provincial laboratories. Data was collected prospectively from August 2012 to May 2013 from routine laboratory and treatment registers.ResultsA total of 5,611 Xpert tests were performed mostly targeting contacts of MDR-TB patients, ‘other’ presumptive MDR-TB patients, and retreatment cases (26%, 24% and 22%, respectively). Compared to phenotypic DST, the positive predictive value of Xpert to detect RR-TB was 93.1% and 96.4% and the negative predictive value was 94.6% and 92.7% using solid and liquid culture media, respectively. RR-TB detection was highest among (former) prisoners, retreatment cases, people living with HIV/AIDS (PLWHA), and TB patients with positive smears after intensive phase of treatment (59%, 58%, 54% and 53% among TB positives, respectively). 88.9% of RR-TB patients were registered to have started second-line TB treatment. Median time to diagnosis with Xpert was 0.0 days (IQR 0.0-1.0), time from diagnosis to start of first-line treatment 3.0 days (IQR 1.0-7.0), and to start of second-line treatment 7.0 days (IQR 4.0-16).ConclusionsCompared to conventional culture and DST, Xpert had a shorter result turn-around-time and excellent concordance to detect RR-TB. Time from sputum collection to start of second-line treatment was reduced to one week. The yield of Xpert could be maximized by increasing referrals from penitentiary and HIV centers to TB centers.

show abstract

“…While the use of antiretroviral therapy (ART) with MDR-TB treatment has resulted in improved outcomes in co-infected patients [ 43 , 44 , 45 ], the management of MDR-TB patients with HIV remains highly challenging due to the psychosocial issues around this co-infection. The risk factors for HIV and MDR-TB are largely overlapping [ 46 ]. Issues regarding adherence to treatment for both these diseases remain a challenge as the duration of treatment is long or indefinite for both diseases.…”

Section: Discussionmentioning

confidence: 99%

Psycho-Socio-Economic Issues Challenging Multidrug Resistant Tuberculosis Patients: A Systematic Review

et al. 2016

View full text Add to dashboard Cite

BackgroundLimited treatment options, long duration of treatment and associated toxicity adversely impact the physical and mental well-being of multidrug-resistant tuberculosis (MDR-TB) patients. Despite research advances in the microbiological and clinical aspects of MDR-TB, research on the psychosocial context of MDR-TB is limited and less understood.MethodologyWe searched the databases of PubMed, MEDLINE, Embase and Google Scholar to retrieve all published articles. The final manuscripts included in the review were those with a primary focus on psychosocial issues of MDR-TB patients. These were assessed and the information was thematically extracted on the study objective, methodology used, key findings, and their implications. Intervention studies were evaluated using components of the methodological and quality rating scale. Due to the limited number of studies and the multiple methodologies employed in the observational studies, we summarized these studies using a narrative approach, rather than conducting a formal meta-analysis. We used ‘thematic synthesis’ method for extracting qualitative evidences and systematically organised to broader descriptive themes.ResultsA total of 282 published articles were retrieved, of which 15 articles were chosen for full text review based on the inclusion criteria. Six were qualitative studies; one was a mixed methods study; and eight were quantitative studies. The included studies were divided into the following issues affecting MDR-TB patients: a) psychological issues b) social issues and economic issues c) psychosocial interventions. It was found that all studies have documented range of psychosocial and economic challenges experienced by MDR-TB patients. Depression, stigma, discrimination, side effects of the drugs causing psychological distress, and the financial constraints due to MDR-TB were some of the common issues reported in the studies. There were few intervention studies which addressed these psychosocial issues most of which were small pilot studies. There is dearth of large scale randomized psychosocial intervention studies that can be scaled up to strengthen management of MDR-TB patients which is crucial for the TB control programme.ConclusionThis review has captured the psychosocial and economic issues challenging MDR patients. However there is urgent need for feasible, innovative psychosocial and economic intervention studies that help to equip MDR-TB patients cope with their illness, improve treatment adherence, treatment outcomes and the overall quality of life of MDR-TB patients.

show abstract

Converging risk factors but no association between HIV infection and multidrug-resistant tuberculosis in Kazakhstan

Cited by 18 publications

References 16 publications

Prisoners co‐infected with tuberculosis and HIV: a systematic review

Prisoners co‐infected with tuberculosis and HIV: a systematic review

Effect of Introducing Xpert MTB/RIF to Test and Treat Individuals at Risk of Multidrug-Resistant Tuberculosis in Kazakhstan: A Prospective Cohort Study

Psycho-Socio-Economic Issues Challenging Multidrug Resistant Tuberculosis Patients: A Systematic Review

Contact Info

Product

Resources

About