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. 2023 Jun 1;27(6):444-450.
doi: 10.5588/ijtld.22.0650.

Smoked drug use in patients with TB is associated with higher bacterial burden

B Myers  1 , T Carney  2 , J Rooney  3 , S Malatesta  4 , E J Ragan  3 , L F White  4 , H Natcheva  5 , T C Bouton  3 , S E Weber  3 , M Farhat  6 , H McIlleron  7 , D Theron  8 , C D H Parry  9 , C R Horsburgh  10 , R M Warren  11 , K R Jacobson  3
Affiliations

Smoked drug use in patients with TB is associated with higher bacterial burden

B Myers et al. Int J Tuberc Lung Dis. .

Abstract
in English, French

BACKGROUND: Smoking of illicit drugs may lead to more rapid TB disease progression or late treatment presentation, yet research on this topic is scant. We examined the association between smoked drug use and bacterial burden among patients newly initiated on drug-susceptible TB (DS-TB) therapy.METHODS: Data from 303 participants initiating DS-TB treatment in the Western Cape Province, South Africa, were analyzed. Smoked drug use was defined as self-reported or biologically verified methamphetamine, methaqualone and/or cannabis use. Proportional hazard and logistic regression models (adjusted for age, sex, HIV status and tobacco use) examined associations between smoked drug use and mycobacterial time to culture positivity (TTP), acid-fast bacilli sputum smear positivity and lung cavitation.RESULTS: People who smoked drugs (PWSD) comprised 54.8% (n = 166) of the cohort. TTP was faster for PWSD (hazard ratio 1.48, 95% CI 1.10-1.97; P = 0.008). Smear positivity was higher among PWSD (OR 2.28, 95% CI 1.22-4.34; P = 0.011). Smoked drug use (OR 1.08, 95% CI 0.62-1.87; P = 0.799) was not associated with increased cavitation.CONCLUSIONS: PWSD had a higher bacterial burden at diagnosis than those who do not smoke drugs. Screening for TB among PWSD in the community may facilitate earlier linkage to TB treatment and reduce community transmission.

CONTEXTE:: La consommation de stupéfiants peut augmenter le risque de présentation tardive pour traitement antituberculeux, mais les recherches sur ce sujet sont rares. Nous avons examiné l’association entre la consommation de drogues fumées et la charge bactérienne chez les patients nouvellement placés sous traitement pour TB pharmacosensible (DS-TB).

MÉTHODES:: Les données de 303 participants commencant un traitement contre la DS-TB dans la province du Cap occidental, Afrique du Sud, ont été analysées. La consommation de drogues fumées a été définie comme la consommation de méthamphétamine, de méthaqualone et/ou de cannabis, auto-déclarée ou vérifiée biologiquement. Des modéles de hasard proportionnel et de regression logistique (ajustés pour l’âge, le sexe, le statut VIH et le tabagisme) ont permis d’examiner les associations entre la consommation de drogues fumes et le délai avant positivité des cultures mycobactériennes (TTP), la positivité des frottis d’expectoration aux bacilles acido-alcoolo-résistants et la cavitation pulmonaire.

RÉSULTATS:: Les fumeurs de drogues (PWSD) représentaient 54,8% (n = 166) de la cohorte. Le TTP était plus rapide chez les PWSD (rapport de risque 1,48 ; IC 95% 1,10–1,97 ; P = 0,008). La positivité des frottis était plus élevée chez les PWSD (OR 2,28 ; IC 95% 1,22–4,34 ; P = 0,011). La consommation de drogues fumées (OR 1,08 ; IC 95% 0,62–1,87 ; P = 0,799) n’etait ´ pasassociée à une augmentation de la cavitation.

CONCLUSIONS :: La charge bactérienne au moment du diagnostic était plus élevée chez les PWSD que chez les non-fumeurs de drogues. Le dépistage communautaire de la TB chez les PWSD peut permettre la prescription précoce du traitement antituberculeux et réduire la transmission au sein de la communauté.

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Figures

Figure
Figure
Predicted survival curves for the estimated cure model of smoked drug use and baseline sputum culture time to positivity.
See this image and copyright information in PMC

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