Early culture conversion is a poor marker of treatment outcome among people with HIV and drug‐resistant TB

Abstract

Objective Our objective was to determine associations between early (≤2 months) culture conversion (ECC) among people with HIV and drug‐resistant tuberculosis (DRTB) in Uganda. Methods This was a countrywide retrospective cohort of people with bacteriologically confirmed DRTB and a positive baseline culture at 16 centres in Uganda between 2013 and 2019. Data were abstracted from treatment files and unit DRTB registers. Monthly sputum cultures were performed using the Lowenstein–Jensen solid medium. Results We included 664 people with DRTB and a positive baseline culture, of whom 353 (53.4%) also had HIV. Among those living with HIV, 225 (63.7%) were male and 331 (94.3%) were on antiretroviral therapy. The median month of culture conversion was 2 (interquartile range [IQR] 1–3). ECC was observed among 226 people living with HIV (64.0%; 95% confidence interval [CI] 58.9–68.9). A DRTB treatment regimen of six or more drugs was associated with ECC among people living with HIV (adjusted odds ratio [aOR] 3.82; 95% CI 1.06–13.82; p = 0.041). Cure and overall treatment success was observed among 232 (65.7%) and 269 (76.2%) people living with HIV, respectively. However, ECC was not associated with cure (crude odds ratio [OR] 0.97; 95% CI 0.61–1.54; p = 0.901), death (OR 1.12; 95% CI 0.61–2.29; p = 0.610), or overall treatment success (OR 1.29; 95% CI 0.78–2.13; p = 0.326). Conclusion The majority of people living with HIV and DRTB achieve ECC. However, ECC does not predict cure, death, or treatment success. Moreover, it may require six or more drugs to achieve ECC. ECC is not an excellent indicator of the effectiveness of DRTB regimens among people living with HIV.

Second-line drug resistance markers as proxy indicators of time to sputum culture conversion among second-line drug resistant tuberculosis patients tested in Uganda: A cross-sectional study

“…11,12 Culture conversion has been widely investigated, with reported inconsistent findings. 13,14 Although less intensive efforts have focused on investigating the variables and risk factors associated with time to sputum culture conversion among multi-drug resistant tuberculosis patients in Sub-Saharan Africa, 15 a median time of 61.2 days has been reported in the East African region and nutritional support has been cited as a possible route for improving TB treatment outcomes among multi-drug resistant tuberculosis (MDR-TB) patients in Eastern Africa 13 and India. 16 A study conducted on 100 participants in Uganda established that 45% of them had converted by the second month, with combined Löwenstein-Jensen and Mycobacteria growth indicator tube (MGIT) culture methods throughout the 6-months for treatment monitoring.…”