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. 2020 Oct 1;24(10):1024-1031.
doi: 10.5588/ijtld.20.0048.

Treatment outcomes in patients with drug-resistant TB-HIV co-infection treated with bedaquiline and linezolid

N Padayatchi  1 , N Bionghi  2 , F Osman  1 , N Naidu  1 , N Ndjeka  3 , I Master  4 , J C M Brust  5 , K Naidoo  1 , A Ramjee  1 , M O Donnell  6
Affiliations

Treatment outcomes in patients with drug-resistant TB-HIV co-infection treated with bedaquiline and linezolid

N Padayatchi et al. Int J Tuberc Lung Dis. .

Abstract

BACKGROUND: Bedaquiline (BDQ) has not been extensively studied among patients co-infected with HIV drug-resistant tuberculosis (DR-TB). We compared treatment outcomes in DR-TB patients treated with BDQ- and linezolid (LZD) containing regimens to historic controls treated with second-line injectable-containing regimens.METHODS: Retrospective cohort study of consecutive DR-TB patients initiated on BDQ- and LZD-containing regimens at a TB referral hospital in KwaZulu-Natal, South Africa. Participants were prospectively followed through 24 months for treatment outcome and adverse events. Outcomes were compared to a historic control cohort of DR-TB HIV patients enrolled at the same facility prior to BDQ introduction.RESULTS: Adult DR-TB patients initiating BDQ between January 2014 and November 2015 were enrolled (n = 151). The majority of patients were female (52%), HIV co-infected (77%) and on antiretroviral therapy (100%). End of treatment outcomes included cure (63%), TB culture conversion (83%), completion (0.7%), loss to follow-up (15%), treatment failure (5%), and death (17%). Compared to historic controls (n = 105), patients treated with BDQ experienced significantly higher TB culture conversion and cure, with significantly lower mortality. Adverse effects were common (92%), and most frequently attributed to LZD (24.1%). QT segment prolongation was common but without clinical sequelae.CONCLUSION: Treatment with BDQ- and LZD-containing regimens was associated with improved treatment outcomes and survival in DR-TB HIV patients.

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Figures

Figure 1a:
Figure 1a:
Kaplan Meier estimates of time to sputum culture conversion stratified by study group (N=175). Median time to culture conversion for BLIX cohort is 60 (36 – 106) days. Median time to culture conversion for Historical control cohort is 124 (54 – 347) days.
Figure 1b:
Figure 1b:
Kaplan Meier estimates of time death stratified by study group (N=256). Median time to death for BLIX cohort is 651 (427 – 735) days. Median time to death for Historical control cohort is 550 (198 – 731) days.
Figure 1c:
Figure 1c:
Kaplan Meier estimates of time to sputum culture conversion stratified by study group and HIV status (N=175).
Figure 1d:
Figure 1d:
Kaplan Meier estimates of time to time to death stratified by study group and HIV status (N=256).
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