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Clinical Trial
. 2011;6(7):e20436.
doi: 10.1371/journal.pone.0020436. Epub 2011 Jul 22.

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

Jason E Farley  1 , Malathi Ram, William Pan, Stacie Waldman, Gail H Cassell, Richard E Chaisson, Karin Weyer, Joey Lancaster, Martie Van der Walt
Affiliations
Clinical Trial

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

Jason E Farley et al. PLoS One. 2011.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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Conflict of interest statement

Competing Interests: Dr. Cassell and Ms. Waldman were previously employed by Eli Lily, Inc. at the time of the funding and data collection. Neither at the time of submission and for the proceeding 6 months were the authors employed with Eli Lily or any other commercial company. Dr. Cassell is an advisory board member of the Johns Hopkins University School of Nursing and Board Member to Burroughs Wellcome. As a mentor to both Dr. Farley and Ms. Waldman during this time she facilitated securing this grant from BW to assist in their participation/conduct of this study. At no time was she compensated by Eli Lily for this study, influenced by the company to alter study aims, nor was she required to report any data on this study to Eli Lily, Inc. Although Ms. Waldman was employed with Eli Lily at the time of data collection, she took personal vacation to conduct study related duties. This experience was part of her MPH capstone project at the Bloomberg School of Public Health. At no time was she compensated, influenced or required to report any data on this study to Eli Lily, Inc. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Cumulative Incidence of Treatment Outcomes by HIV status and weight group.
A =  Failure; B =  Default; C =  Died.
See this image and copyright information in PMC

References

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