Do HIV infection and antiretroviral therapy influence multidrug-resistant tuberculosis treatment outcomes?

Abstract

The aim of this study was to find out whether human immunodeficiency virus (HIV)-infection and antiretroviral drugs influence multidrug-resistant (MDR)-tuberculosis (TB) treatment outcomes. The study compares MDR-TB treatment outcomes between HIV-positive and HIV-negative patients. It involved patients admitted for treatment of MDR-TB between 1 January 2004 and 31 December 2006. From 363 patients selected, 268 (177 males and 91 females) had MDR-TB and 95 patients (59 males and 36 females) were co-infected with HIV. Children in the HIV-negative group were 41 and 7 in the HIV-positive group. The HIV-infection was treated with Stavudine, Lamivudine and Efavirenz in 54 patients. Kanamycin, Ethionamide, Ofloxacin, Terizidone, Pyrazinamide and Ethambutol were used for MDR-TB treatment. In HIV-negative and HIV-positive patients MDR-TB treatment outcomes were, respectively as follows: 37 and 35% cure, 9 and 5% treatment failure, 20 and 25% lost to follow up, 11 and 17% mortality, 19 and 13% treatment completed, 6 and 5% transfer-out. The cure rate was 100% in children. In HIV-positive patients, MDR-TB cure rate was 35% in patients on ARVs and 34% in patients not receiving ARVs. The difference between these cure rates is not statistically significant (p-value = 0.79). The median (range) duration of ART before the start of MDR-TB treatment was 10.5 (1 to 60) months and did not influence MDR-TB treatment outcomes. In children, the full treatment was supervised in hospital. This could explain the 100% cure rate. Adults' treatment was supervised in hospital only during the intensive phase then followed up as out patients over 18 months. According to the results of this study, HIV-infection and antiretroviral therapy did not influence MDR-TB treatment outcomes.