Treatment Outcomes for Patients with Multidrug-Resistant Tuberculosis in Post-Earthquake Port-au-Prince, Haiti

Abstract

Abstract. We report outcomes and 12-month survival for the first cohort of patients to undergo multidrug-resistant tuberculosis (MDR-TB) treatment after the earthquake in Haiti. From March 3, 2010 to March 28, 2013, 110 patients initiated treatment of laboratory-confirmed MDR-TB at the Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Center in Port-au-Prince, Haiti. Twenty-seven patients (25%) were human immunodeficiency virus (HIV)-positive. As of October 31, 2013, 95 (86%) patients were either cured or alive on treatment, 4 (4%) patients defaulted, and 11 (10%) patients died. Culture conversion occurred by 30 days in 14 (13%) patients, 60 days in 49 (45%) patients, and 90 days in 81 (74%) patients. The probabilities of survival to 12 months were 96% (95% confidence interval [95% CI] = 89-99) and 85% (95% CI = 64-94) for HIV-negative and -positive patients, respectively. Despite adverse conditions, outcomes for patients with MDR-TB are highly encouraging. Major efforts are underway to scale up community directly observed therapy and expand care to other regions of Haiti.

Survival of smear-positive multidrug resistant tuberculosis patients in Witbank, South Africa: A retrospective cohort study

“…The finding of the current study is also consistent with those of previous studies [18][19][20], having shown that the risk of death among those who had HIV co-infection increased by two. This underscores the need to give priority attention to MDR-TB patients with HIV coinfection.…”

Sputum Smear Conversion Time of HIV Infected and Uninfected Patients with Rifampicin and Isoniazid Mycobacterium tuberculosis gene Mutations in Western Kenya

“…In our study, these mutations were identified in two HIV coinfected patients who had a 100% smear conversion rate at 11 months and 8 months respectively (Table 1). This finding emphasizes the importance of prolonged RIF TB therapy for improved treatment outcome (15,16) . However previous studies have shown that smear microscopy is less sensitive in HIV positive patients with MDR-TB and cure should be confirmed after obtaining at least 5 negative sputum culture results during 12 months of treatment (6) .…”

Potentially High Number of Ineffective Drugs with the Standard Shorter Course Regimen for Multidrug-Resistant Tuberculosis Treatment in Haiti

“…There are several ongoing clinical trials examining such novel regimens. [41][42][43] Treatment outcomes for MDR-TB in Haiti are among the best in the world, 16,17 with the use of standard long-course therapy in conjunction with DST. The Haitian National TB Program is in the process of selecting a shorter course regimen that would lead to continued high success rates, without increasing toxicity.…”

“…Despite suffering a devastating earthquake in 2010, MDR-TB treatment outcomes have been excellent with cure rates as high as 88%. 16,17 Ethics. This study was approved by the institutional review boards of all affiliated institutions.…”