Successful Multidrug-Resistant Tuberculosis Treatment Without HIV Viral Suppression: A Missed Opportunity

Abstract

Background Co-infection with multidrug-resistant tuberculosis (MDR-TB) and human immunodeficiency virus (HIV) is common, but few published studies examine how undergoing MDR-TB treatment impacts HIV disease indicators. Methods Using data from a nested, retrospective cohort of people with HIV (PWH) and successful MDR-TB treatment outcomes, we built multivariable regression models to explore correlates of HIV viral suppression at MDR-TB treatment completion. Results Among 532 PWH successfully treated for MDR-TB, mean age was 37.4 years (SD 10.2, IQR 30-43), 271 (50.9%) were male, 396 (74.4%) were virally suppressed at MDR-TB outcome, and 259 (48.7%) took bedaquiline. Older age (aOR 1.04, 95% CI 1.01-1.06) increased odds of viral suppression, while having a prior TB episode (aOR 0.45, 95% CI 0.31-0.64), having a detectable viral load at MDR-TB treatment initiation (aOR 0.17, 95% CI 0.09-0.30), living in a township (aOR 0.49, 95% CI 0.28-0.86), and being changed from efavirenz-based antiretroviral therapy (ART) to a protease inhibitor due to bedaquiline usage (aOR 0.19, 95% CI 0.04-0.81) or not having an ART change while on bedaquiline (aOR 0.29, 95% CI 0.11-0.75) lowered odds of viral suppression. Changing from efavirenz to nevirapine due to bedaquiline usage did not significantly affect odds of viral suppression (aOR 0.40, 95% CI 0.16-1.04). Conclusion Increased pill burden and adverse treatment effects did not significantly affect HIV viral suppression, while switching ART to a protease inhibitor to accommodate bedaquiline or not changing ART while taking bedaquiline did, suggesting that PWH and MDR-TB may benefit from additional support if they must switch ART.