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

Abstract

BackgroundThe 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.MethodsWe 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.ResultsOf 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.ConclusionsAs 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.

Unfavorable outcomes to second-line tuberculosis therapy among HIV-infected versus HIV-uninfected patients in sub-Saharan Africa: A systematic review and meta-analysis

“…Significantly increased risks of an unfavorable outcome to second-line anti-tuberculosis treatment among HIV-infected versus HIV-uninfected patients were revealed for some patient groups (i.e., 1.22 times higher in mixed-age patients and 1.47 times higher in the eastern region of SSA, compared to their respective counterparts), but the increases in rest of the subgroups were not significant. Consistently, reports of previous studies involving mixed-age patients indicated that older HIV-infected patients had 1.53 [64] and 4.8 [49] times higher hazards of unfavorable outcomes than those older HIV-uninfected. Again, pediatric and elderly individuals were among the mixed-age patients in whom immune statuses might not be competent compared with that of adults/adolescents counterparts.…”

“…A non-significant decrease in the pooled risk of loss from treatment estimated was 0.82 times lower in HIV-infected patients than in those HIV-uninfected. In agreement to this finding, study reports indicated 11.8% versus 26.2% (P<0.001) and 14.2% versus 35.2% rates of loss to follow-up among the HIV-infected versus HIV-uninfected patients; and the loss to follow-up was 7.67 (95% CI: 1.00-59.0) times more likely in the HIV-uninfected patients than in those HIV-infected [80][81][82]. Also, reminding information via cell phone as a part of the HIV/TB integrated program enabled tracing lost patients and resulted in twice more likely returnee for traced patients than untracked ones [83].…”

Characteristics of tuberculosis patients in the integrated tuberculosis control model in Chongqing, China: a retrospective study

“…Previous studies reported that HIV and DR-TB were the risk factors for each other [ 39 – 41 , 47 ]. However, this study found no association between HIV-positive and DR-TB patients among TB patients in Chongqing.…”

The effects of MDR/RR-TB treatment on HIV disease: A systematic review of literature

“…However, these reviews focus on MDR/RR-TB indicators with limited or no discussion of how MDR/RR-TB treatment affects HIV disease. Despite the extra challenges that HIV co-infection adds to MDR/RR-TB treatment, some studies have shown similar MDR/RR-TB treatment success rates among HIV-positive and HIV-negative MDR/RR-TB patients when ART is available [ 10 , 11 ]. As HIV disease management requires lifelong ART extending well beyond MDR/RR-TB cure, examining how MDR/RR-TB treatment affects HIV disease, its treatment, and its progression is crucial [ 3 ].…”