Outcomes of HIV-infected patients treated for recurrent tuberculosis with the standard retreatment regimen

Abstract

SETTING AIDS and tuberculosis center in Port-au-Prince, Haiti. OBJECTIVE To measure the effectiveness of tuberculosis retreatment with the standard regimen (2HRZES/1HRZE/5HRE) in HIV-infected adults. DESIGN Cohort study. RESULTS Of 1,318 HIV-infected patients with access to antiretroviral therapy following World Health Organization guidelines, 56 were diagnosed with recurrent pulmonary tuberculosis and retreated with the standard regimen. Ten patients (18%) died during retreatment, 3 patients (5%) defaulted, and 2 patients (4%) failed. Forty-one patients (73%) had a good retreatment outcome (cure, treatment completed). Of these, 8 patients (20%) died during follow-up, 5 patients (12%) were lost, and 5 patients (12%) had a second recurrence of tuberculosis. Only 26 (46%) of the 56 patients remained alive, in-care, and TB-free after a median of 36 months follow-up. CONCLUSION HIV-infected patients treated for recurrent tuberculosis with the standard retreatment regimen have a high mortality and poor long-term outcomes.

Outcomes across the tuberculosis care continuum among adolescents in Haiti

“…Age, sex, residence, education, timing of treatment initiation, and HIV status at TB diagnosis were included in adjusted models based on their previous association with TB treatment outcomes. 11,22 Variables were treated categorically. Weight was excluded due to a high proportion of missing data and our hypothesis that weight may not be missing at random.…”

“…Our results indicate that adolescents who start treatment have outcomes similar to those of adults on anti-tuberculosis treatment in Haiti. [22][23][24] This is encouraging, considering that adolescents have worse treatment outcomes for similarly stigmatised diseases such as HIV. 25,26 However, our study also includes data on the number of adolescents lost between TB testing and initiating anti-tuberculosis treatment, part of the care cascade that is rarely captured, 24,27 and shows that the greatest loss (16%) of patients occurred between diagnosis and treatment initiation.…”

Poor outcomes in recurrent tuberculosis: More than just drug resistance?

“…In 1991, The World Health Organization (WHO) recommended that people presenting with TB in settings with a low prevalence of multidrug-resistant TB (MDR-TB) who have previously been treated were prescribed a standardised regimen consisting of Rifampicin(R), Isoniazid(H), Pyrazinamide(Z), Ethambutol(E) and Streptomycin(S) for 2 months, followed by RHZE for 1 month and then RHE for 5 months [3]. This ‘Category II’ regimen has no clinical trial evidence base, and treatment outcomes in this group of patients are persistently reported to be poor [4–7]. The most recent WHO TB treatment guidelines therefore recommend discontinuation of the Category II regimen where possible in favour of regimens which are guided by the results of drug susceptibility testing (DST) [8].…”

A systematic review of clinical outcomes on the WHO Category II retreatment regimen for tuberculosis

“… 36 In a study by McGreevy et al, follow-up data demonstrated that only 46% of HIV-positive patients remained alive, in ART care and TB-free after a median of 36 months of follow-up. 46 …”