Outcomes of multi-drug resistant tuberculosis (MDR-TB) among a cohort of South African patients with high HIV prevalence

Multidrug-resistant tuberculosis (MDR-TB) is a major clinical challenge, particularly in patients with human immunodeficiency virus (HIV) co-infection. MDR-TB treatment is increasingly available, but outcomes have not been well characterized. South Africa has provided MDR-TB treatment for a decade,...

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Veröffentlicht in:	PloS one 2011-07, Vol.6 (7), p.e20436-e20436
Hauptverfasser:	Farley, Jason E, Ram, Malathi, Pan, William, Waldman, Stacie, Cassell, Gail H, Chaisson, Richard E, Weyer, Karin, Lancaster, Joey, Van der Walt, Martie
Format:	Artikel
Sprache:	eng
Schlagworte:	Adolescent Adult Aged Analysis Antiretroviral agents Antitubercular agents Clinical outcomes Cohort Studies Councils Death Drug dosages Drug resistance Drug therapy Drugs Epidemiology Hazards Health aspects Health hazards Health risks HIV HIV infections HIV Infections - complications HIV Infections - epidemiology Human immunodeficiency virus Humans Infections Male Medical diagnosis Medical research Medicine Middle Aged Mortality Multidrug resistance Multidrug resistant organisms Patients Prevalence Public health Risk analysis South Africa - epidemiology Treatment Outcome Tuberculosis Tuberculosis, Multidrug-Resistant - complications Tuberculosis, Multidrug-Resistant - drug therapy Viruses Young Adult
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description	Multidrug-resistant tuberculosis (MDR-TB) is a major clinical challenge, particularly in patients with human immunodeficiency virus (HIV) co-infection. MDR-TB treatment is increasingly available, but outcomes have not been well characterized. South Africa has provided MDR-TB treatment for a decade, and we evaluated outcomes by HIV status for patients enrolled between 2000 and 2004 prior to anti-retroviral access. We assessed treatment outcomes in a prospective cohort of patients with MDR-TB from eight provincial programs providing second line drugs. World Health Organization definitions were used. Results were stratified by HIV status. Seven hundred fifty seven patients with known HIV status were included in the final analysis, and HIV infection was documented in 287 (38%). Overall, 348 patients (46.0%) were successfully treated, 74 (9.8%) failed therapy, 177 (23.4%) died and 158 (20.9%) defaulted. Patients with HIV were slightly younger and less likely to be male compared to HIV negative patients. Patients with HIV were less likely to have a successful treatment outcome (40.0 vs. 49.6; P
doi_str_mv	10.1371/journal.pone.0020436
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MDR-TB treatment is increasingly available, but outcomes have not been well characterized. South Africa has provided MDR-TB treatment for a decade, and we evaluated outcomes by HIV status for patients enrolled between 2000 and 2004 prior to anti-retroviral access. We assessed treatment outcomes in a prospective cohort of patients with MDR-TB from eight provincial programs providing second line drugs. World Health Organization definitions were used. Results were stratified by HIV status. Seven hundred fifty seven patients with known HIV status were included in the final analysis, and HIV infection was documented in 287 (38%). Overall, 348 patients (46.0%) were successfully treated, 74 (9.8%) failed therapy, 177 (23.4%) died and 158 (20.9%) defaulted. Patients with HIV were slightly younger and less likely to be male compared to HIV negative patients. Patients with HIV were less likely to have a successful treatment outcome (40.0 vs. 49.6; P<0.05) and more likely to die (35.2 vs. 16.2; P<0.0001). In a competing risk survival analysis, patients with HIV had a higher hazard of death (HR: 2.33, P<0.0001). Low baseline weight (less than 45 kg and less than 60 kg) was also associated with a higher hazard of death (HR: 2.52, P<0.0001; and HR: 1.50, P<0.0001, respectively, compared to weight greater than 60 kg). Weight less than 45 kg had higher risk of failure (HR: 3.58, P<0.01). Any change in treatment regimen was associated with a higher hazard of default (HR: 2.86; 95% CI 1.55-5.29, P<0.001) and a lower hazard of death (HR: 0.63, P<0.05). In this MDR-TB treatment program patients with HIV infection and low weight had higher hazards of death. Overall treatment outcomes were poor. 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MDR-TB treatment is increasingly available, but outcomes have not been well characterized. South Africa has provided MDR-TB treatment for a decade, and we evaluated outcomes by HIV status for patients enrolled between 2000 and 2004 prior to anti-retroviral access. We assessed treatment outcomes in a prospective cohort of patients with MDR-TB from eight provincial programs providing second line drugs. World Health Organization definitions were used. Results were stratified by HIV status. Seven hundred fifty seven patients with known HIV status were included in the final analysis, and HIV infection was documented in 287 (38%). Overall, 348 patients (46.0%) were successfully treated, 74 (9.8%) failed therapy, 177 (23.4%) died and 158 (20.9%) defaulted. Patients with HIV were slightly younger and less likely to be male compared to HIV negative patients. Patients with HIV were less likely to have a successful treatment outcome (40.0 vs. 49.6; P<0.05) and more likely to die (35.2 vs. 16.2; P<0.0001). In a competing risk survival analysis, patients with HIV had a higher hazard of death (HR: 2.33, P<0.0001). Low baseline weight (less than 45 kg and less than 60 kg) was also associated with a higher hazard of death (HR: 2.52, P<0.0001; and HR: 1.50, P<0.0001, respectively, compared to weight greater than 60 kg). Weight less than 45 kg had higher risk of failure (HR: 3.58, P<0.01). Any change in treatment regimen was associated with a higher hazard of default (HR: 2.86; 95% CI 1.55-5.29, P<0.001) and a lower hazard of death (HR: 0.63, P<0.05). In this MDR-TB treatment program patients with HIV infection and low weight had higher hazards of death. Overall treatment outcomes were poor. Efforts to improve treatment for MDR-TB are urgently needed.]]></description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Analysis</subject><subject>Antiretroviral agents</subject><subject>Antitubercular agents</subject><subject>Clinical outcomes</subject><subject>Cohort Studies</subject><subject>Councils</subject><subject>Death</subject><subject>Drug dosages</subject><subject>Drug resistance</subject><subject>Drug therapy</subject><subject>Drugs</subject><subject>Epidemiology</subject><subject>Hazards</subject><subject>Health aspects</subject><subject>Health hazards</subject><subject>Health risks</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - epidemiology</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infections</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multidrug resistance</subject><subject>Multidrug resistant organisms</subject><subject>Patients</subject><subject>Prevalence</subject><subject>Public health</subject><subject>Risk analysis</subject><subject>South Africa - epidemiology</subject><subject>Treatment Outcome</subject><subject>Tuberculosis</subject><subject>Tuberculosis, Multidrug-Resistant - complications</subject><subject>Tuberculosis, Multidrug-Resistant - drug therapy</subject><subject>Viruses</subject><subject>Young Adult</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNptUktv1DAYjBCIlsI_QGCJA3DI4kfi2BekpTy6UlElKFwtx_mS9SqJt7ZT4N_jZdOqiyofbI1nxv5Gk2XPCV4QVpF3Gzf5UfeLrRthgTHFBeMPsmMiGc05xezhnfNR9iSEDcYlE5w_zo4oqaSsqDjOfl9M0bgBAnItGqY-2rzxU4c8BBuiHiOKUw3eTL1LAHrz9eO3_PLDW6QHN3ZII-PWzsed-Lub4hotW2-NHtFWRwtjDOiXTejadmt0tvqJth6udQ-jgafZo1b3AZ7N-0n24_Ony9Oz_Pziy-p0eZ6bUtKYE5C1lkILaGRbmdJA1RhSNsZgwjXRZSulKEkJhtRNC7oFXtW4EsAJYyVwdpK93Ptu0wRqDi0ownBicMlEYqz2jMbpjdp6O2j_Rzlt1T_A-U5pH63pQdWYaZASU8GhqFipNWaUyoITqOqW1snr_fzaVA_QmBSB1_2B6eHNaNeqc9eKkYISLJPB69nAu6sJQlSDDQb6Xo_gpqCEwISVQpaJ-eo_5v3Dzawuxa7s2Lr0rNl5qmVRcSEKTGliLe5hpdXAYE0qWGsTfiAo9gLjXQge2tsRCVa7et58Ru3qqeZ6JtmLu_Hcim76yP4CAljjAQ</recordid><startdate>20110722</startdate><enddate>20110722</enddate><creator>Farley, Jason E</creator><creator>Ram, Malathi</creator><creator>Pan, William</creator><creator>Waldman, Stacie</creator><creator>Cassell, Gail H</creator><creator>Chaisson, Richard E</creator><creator>Weyer, Karin</creator><creator>Lancaster, Joey</creator><creator>Van der Walt, Martie</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20110722</creationdate><title>Outcomes of multi-drug resistant tuberculosis (MDR-TB) among a cohort of South African patients with high HIV prevalence</title><author>Farley, Jason E ; Ram, Malathi ; Pan, William ; Waldman, Stacie ; Cassell, Gail H ; Chaisson, Richard E ; Weyer, Karin ; Lancaster, Joey ; Van der Walt, Martie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c592t-1e9ba98a8ed9f7c5ce7dc15dcc016a1a5f998515ec1bdfeafe67b078e61335e63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Analysis</topic><topic>Antiretroviral agents</topic><topic>Antitubercular agents</topic><topic>Clinical outcomes</topic><topic>Cohort Studies</topic><topic>Councils</topic><topic>Death</topic><topic>Drug dosages</topic><topic>Drug resistance</topic><topic>Drug therapy</topic><topic>Drugs</topic><topic>Epidemiology</topic><topic>Hazards</topic><topic>Health aspects</topic><topic>Health hazards</topic><topic>Health risks</topic><topic>HIV</topic><topic>HIV infections</topic><topic>HIV Infections - 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MDR-TB treatment is increasingly available, but outcomes have not been well characterized. South Africa has provided MDR-TB treatment for a decade, and we evaluated outcomes by HIV status for patients enrolled between 2000 and 2004 prior to anti-retroviral access. We assessed treatment outcomes in a prospective cohort of patients with MDR-TB from eight provincial programs providing second line drugs. World Health Organization definitions were used. Results were stratified by HIV status. Seven hundred fifty seven patients with known HIV status were included in the final analysis, and HIV infection was documented in 287 (38%). Overall, 348 patients (46.0%) were successfully treated, 74 (9.8%) failed therapy, 177 (23.4%) died and 158 (20.9%) defaulted. Patients with HIV were slightly younger and less likely to be male compared to HIV negative patients. Patients with HIV were less likely to have a successful treatment outcome (40.0 vs. 49.6; P<0.05) and more likely to die (35.2 vs. 16.2; P<0.0001). In a competing risk survival analysis, patients with HIV had a higher hazard of death (HR: 2.33, P<0.0001). Low baseline weight (less than 45 kg and less than 60 kg) was also associated with a higher hazard of death (HR: 2.52, P<0.0001; and HR: 1.50, P<0.0001, respectively, compared to weight greater than 60 kg). Weight less than 45 kg had higher risk of failure (HR: 3.58, P<0.01). Any change in treatment regimen was associated with a higher hazard of default (HR: 2.86; 95% CI 1.55-5.29, P<0.001) and a lower hazard of death (HR: 0.63, P<0.05). In this MDR-TB treatment program patients with HIV infection and low weight had higher hazards of death. Overall treatment outcomes were poor. Efforts to improve treatment for MDR-TB are urgently needed.]]></abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>21799728</pmid><doi>10.1371/journal.pone.0020436</doi><oa>free_for_read</oa></addata></record>
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subjects	Adolescent Adult Aged Analysis Antiretroviral agents Antitubercular agents Clinical outcomes Cohort Studies Councils Death Drug dosages Drug resistance Drug therapy Drugs Epidemiology Hazards Health aspects Health hazards Health risks HIV HIV infections HIV Infections - complications HIV Infections - epidemiology Human immunodeficiency virus Humans Infections Male Medical diagnosis Medical research Medicine Middle Aged Mortality Multidrug resistance Multidrug resistant organisms Patients Prevalence Public health Risk analysis South Africa - epidemiology Treatment Outcome Tuberculosis Tuberculosis, Multidrug-Resistant - complications Tuberculosis, Multidrug-Resistant - drug therapy Viruses Young Adult
title	Outcomes of multi-drug resistant tuberculosis (MDR-TB) among a cohort of South African patients with high HIV prevalence
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