Öz
Background:The synergistic effect between multidrug resistant Mycobacterium tuberculosis (MDR-TB) and HIV remains a public health challenge in the management of co infected patients. Various researchers have documented the treatment outcome of patients with MDR-TB but few studies have explored the correlates of treatment outcome among MDR-TB patients co-infected with HIV. This study aimed to identify the correlates of treatment outcome among hospitalized MDR-TB patients during the intensive phase of treatment.
Method:A retrospective review of records of MDR-TB patients admitted at a specialist treatment center in Oyo State from 2012 – 2016 was conducted. Descriptive statistics such as frequencies, proportions and relevant summary indices were obtained while bivariate analysis was done using chi square test to identify factors associated with treatment outcome. Predictors of treatment outcome were identified by fitting a binary logistic regression. All statistical significance was set at 5%.
Result:A total of 141 patients had complete records within the study period with mean age of 36.3±11.6 years. Prevalence of MDR-TB/HIV co-infection was 12.1% with the highest proportion among those aged 45 years above and females. Over 80% of the respondents had a favorable outcome, however among the HIV co infected patients, there was a higher proportion with unfavorable outcome (23.5% vs 14.5%). In addition, females were found to be about six times more likely to experience unfavorable outcomes than their male counterparts (A.O.R:5.7; 95% C.I:1.51-20.7).
Conclusion:A high prevalence of MDR-TB/HIV coinfection rate was seen. Although majority of the patients had good treatment outcome, MDR-TB/HIV co infected patients as well as females had poorer treatment outcome. The management of these patients need to be optimized during hospitalization.
Keywords: Treatment outcome, drug resistance, HIV, tuberculosis
Résumé
L’effet synergique entre la tuberculose multirésistante Mycobacterium tuberculose (TB-MR) et le VIH reste un défi de santé publique dans la prise en charge des patients coinfectés. Divers chercheurs ont documenté les résultats du traitement des patients atteints de TB-MR, mais peu d’études ont exploré les corrélats des résultats du traitement chez les patients TB-MR coinfectés par le VIH. Cette étude visait à identifier les corrélats des résultats du traitement chez les patients hospitalisés pour TB-MR pendant la phase intensive du traitement. Un examen rétrospectif des dossiers des patients atteints de TB-MR admis dans un centre de traitement spécialisé dans l’État d’Oyo de 2012 à 2016 a été effectué. Des statistiques descriptives telles que les fréquences, les proportions et les indices de synthèse pertinents ont été obtenues tandis qu’une analyse bivariée a été effectuée en utilisant le test du chi carré pour identifier les facteurs associés au résultat du traitement. Les prédicteurs du résultat du traitement ont été identifiés en ajustant une régression logistique binaire. Toute la signification statistique a été fixée à 5%. Un total de 141 patients avait des dossiers complets au cours de la période d’étude avec un âge moyen de 36,3 ± 11,6 ans. La prévalence de la co-infection MDR-TB / VIH était de 12,1%, la proportion la plus élevée étant observée chez ceux âgés de 45 ans et plus et les femmes. Plus de 80% des répondants ont eu une issue favorable, cependant parmi les patients coinfectés par le VIH, il y avait une proportion plus élevée avec une issue défavorable (23,5% vs 14,5%). De plus, les femmes étaient six fois plus susceptibles de connaître des résultats défavorables que leurs homologues masculins (AOR: 5,7; IC à 95%: 1,51-20,7). Une prévalence élevée du taux de co- infection MDR-TB / VIH a été observée. Bien que la majorité des patients aient eu de bons résultats de traitement, les patients coinfectés par la TB-MR / VIH et les femmes ont eu de moins bons résultats de traitement. La prise en charge de ces patients doit être optimisée lors de l’hospitalisation.
Mots-clés: Résultat du traitement, résistance aux médicaments, VIH, tuberculose
Correspondence: Dr. E. Bamgboye, Department of Epidemiology and Medical Statistic, College of Medicine, University of Ibadan, Ibadan, Nigeria. Email: dr_enip@yahoo.co.uk
Referanslar
WHO. Global Tuberculosis Report. WHO Publications, 2015
WHO. WHO drug treatment guidelines for drug resistant tuberculosis, 2016.
C. Dye, B. G. Williams M. A. Espinal and M. C. Raviglione “Erasing the World ’ s Slow Stain/ : Strategies to Beat Multidrug-Resistant Tuberculosis,” vol. 295, no. March, pp. 2042–2047, 2002.S.
Dean A. S., Zignol M., Falzon D., et al. HIV and multidrug-resistant tuberculosis: overlapping epidemics. European Respiratory Journal, 2014; 44(1), 251-254.
Wells C. D., Cegielski J. P., Nelson L. J., et al. HIV Infection and Multidrug-Resistant Tuberculosis—The Perfect Storm. The Journal of Infectious Diseases, 2007; 196(Supplement_1), S86-S107. doi: 10.1086/518665
Federal Ministry of Health. 2014. National Tuberculosis and Leprosy Control Programme(NTBLCP) Report
Oladimeji O., Isaakidis P., Obasanya O. J., et al. Intensive-phase treatment outcomes among hospitalized multidrug-resistant tuberculosis patients: results from a nationwide cohort in Nigeria. 2014;PLoS One, 9(4), e94393. doi: 10.1371/journal.pone.0094393
Balabanova Y., Radiulyte B., Davidaviciene E., et al. Survival of drug resistant tuberculosis patients in Lithuania: retrospective national cohort study. 2011; BMJ Open, 1(2), e000351. doi: 10.1136/bmjopen-2011-000351
Dolgusev O., Obevzenco N., Padalco O., et al. Pattern of primary tuberculosis drug resistance and associated treatment outcomes in Transnistria, Moldova. Public Health Action, 2014; 4(Suppl 2), S64-66. doi: 10.5588/pha.14.0043
Farley J. E., Ram M., Pan W., et al. Outcomes of multi-drug resistant tuberculosis (MDR-TB) among a cohort of South African patients with high HIV prevalence.2011; PLoS One, 6(7), e20436. doi: 10.1371/journal.pone.0020436
Mohr E., Cox V., Wilkinson L., et al. Programmatic treatment outcomes in HIV-infected and uninfected drug-resistant TB patients in Khayelitsha, South Africa. Trans R Soc Trop Med Hyg, 2015; 109(7), 425-432. doi: 10.1093/trstmh/trv037
.12. Seung K. J., Omatayo D. B., Keshavjee S.,et al. Early outcomes of MDR-TB treatment in a high HIV-prevalence setting in Southern Africa. 2009; PLoS One, 4(9), e7186. doi: 10.1371/journal.pone.0007186
Umanah T., Ncayiyana J., Padanilam X., and Nyasulu P. S. Treatment outcomes in multidrug resistant tuberculosis-human immunodeficiency virus Co-infected patients on anti-retroviral therapy at Sizwe Tropical Disease Hospital Johannesburg, South Africa. BMC Infect Dis, 2015; 15, 478. doi: 10.1186/s12879-015-1214-1213
Leimane V., Dravniece G., Riekstina V., et al. Treatment outcome of multidrug/extensively drug-resistant tuberculosis in Latvia, 2000-2004. Eur Respir J, 2010; 36(3), 584-593. doi: 10.1183/09031936.00003710
Kehinde A. O., Adebiyi E. O., Salako A. O., et al. Drug resistance profiles of new- and previously treated patients with pulmonary tuberculosis in Ibadan, Nigeria. Afr J Med Med Sci, 2016; 45(1), 67-73.
O Ige S. Y., EdemVF and OG Arinola. Renal and hepatic profiles in Nigerian multidrug resistant tuberculosis patients with or without HIV co-infection. African Journal of Clinical and Experimental Microbiology, 2015; 16(3), 6. doi: African Journal of Clinical and Experimental Microbiology
Chan E. D., Laurel V., Strand M. J., et al. Treatment and outcome analysis of 205 patients with multidrug-resistant tuberculosis. Am J Respir Crit Care Med, 2004; 169(10), 1103-1109. doi: 10.1164/rccm.200308-1159OC
Chung-Delgado K., Guillen-Bravo S., Revilla-Montag A., and Bernabe-Ortiz A. Mortality among MDR-TB cases: comparison with drug-susceptible tuberculosis and associated factors. 2015;PLoS One, 10(3), e0119332. doi: 10.1371/journal.pone.0119332
Isaakidis P., Casas E. C., Das M., et al. Treatment outcomes for HIV and MDR-TB co-infected adults and children: systematic review and meta-analysis. Int J Tuberc Lung Dis, 2015; 19(8), 969-978. doi: 10.5588/ijtld.15.0123
Anuwatnonthakate A., Whitehead S. J., Varma J. K., et al. Effect of Mycobacterial Drug Resistance Patterns on Patients’ Survival: A Cohort Study in Thailand. Global Journal of Health Science, 5(6), 60-72. doi: 10.5539/gjhs.v5n6p60
Orenstein E. W., Basu S., Shah N. S., et al. Treatment outcomes among patients with multidrug-resistant tuberculosis: systematic review and meta-analysis. Lancet Infect Dis, 2009; 9(3), 153-161. doi: 10.1016/s1473-3099(09)70041-6
Gandhi N. R., et al. “Risk factors for mortality among MDR- and XDR-TB patients in a high HIV prevalence setting.” Int J Tuberc Lung Dis 2012; 16(1): 90-97.
Kawai V., Soto G., Gilman R. H., et al. Tuberculosis mortality, drug resistance, and infectiousness in patients with and without HIV infection in Peru. Am J Trop Med Hyg,2006; 75(6), 1027-1033