Impact of the human immunodeficiency virus on early multidrug-resistant tuberculosis treatment outcomes in Botswana.

TitleImpact of the human immunodeficiency virus on early multidrug-resistant tuberculosis treatment outcomes in Botswana.
Publication TypeJournal Article
Year of Publication2013
AuthorsHafkin J, Modongo C, Newcomb C, Lowenthal ED, MacGregor RR, Steenhoff AP, Friedman H, Bisson GP
JournalInt J Tuberc Lung Dis
Volume17
Issue3
Pagination348-53
Date Published2013 Mar
ISSN1815-7920
KeywordsAdult, Ambulatory Care, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Antitubercular Agents, Botswana, Coinfection, Female, HIV Infections, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Mycobacterium tuberculosis, Pilot Projects, Predictive Value of Tests, Proportional Hazards Models, Retrospective Studies, Risk Factors, Sputum, Time Factors, Treatment Outcome, Tuberculosis, Multidrug-Resistant, Tuberculosis, Pulmonary, Young Adult
Abstract

SETTING: The impact of the human immunodeficiency virus (HIV) on multidrug-resistant tuberculosis (MDR-TB) treatment outcomes in sub-Saharan Africa, where extensive rollout of highly active antiretroviral therapy (HAART) has occurred, remains unclear.

OBJECTIVE: To compare the time to initial culture conversion among patients with and those without HIV infection in a setting of individualized MDR-TB care in Botswana.

DESIGN: Prospective cohort study of MDR-TB patients receiving ambulatory, integrated TB-HIV care at two public clinics in Botswana. The time to culture conversion was compared by HIV status using Cox proportional hazard ratios (HRs).

RESULTS: A total of 40 HIV-infected and 30 non-HIV-infected patients with MDR-TB and follow-up cultures were identified. The median time to initial culture conversion was 78 days (interquartile range [IQR] 42-186) for HIV-infected and 95 days (IQR 70-133) for non-HIV-infected individuals (log rank P > 0.5; unadjusted HR 0.9, 95%CI 0.5-1.5). Adjusting for age, sex, treatment history and number of active anti-tuberculosis drugs did not change this result (adjusted HR 0.8, 95%CI 0.4-1.4).

CONCLUSION: We found no difference in the proportion of or time to initial sputum culture conversion between an HIV-infected and a non-infected cohort of MDR-TB patients in Botswana, suggesting that outcomes may be comparable in similar settings with access to individualized anti-tuberculosis treatment and HAART.

DOI10.5588/ijtld.12.0100
Alternate JournalInt. J. Tuberc. Lung Dis.
PubMed ID23321297
PubMed Central IDPMC4393740
Grant ListK23 MH095669 / MH / NIMH NIH HHS / United States
T32 AI 055435 / AI / NIAID NIH HHS / United States