Survival Outcomes Improved With Concurrent Treatment for Multidrug-Resistant TB and HIV
Mortality was higher in patients whose CD4 was persistently ≤100 cells/mm3. Photo Credit: CDC/ Elizabeth "Libby" White.
Treatment of multidrug-resistant tuberculosis (TB) has comparable efficacy and survival rates in patients infected with HIV and not uninfected with HIV when patients with HIV are given antiretroviral therapy, according to the results of recent research published in Clinical Infectious Diseases.
Researchers recruited 206 adults in South Africa with culture-confirmed multidrug-resistant TB with HIV infection (n=150) or without HIV infection (n=56). During TB treatment, symptoms, adverse events, medication adherence, and sputum sample cultures were evaluated monthly. Following successful treatment, participants were evaluated quarterly for 1 year. Survival and treatment outcomes were compared in both groups.
In 191 participants with final outcomes for multidrug-resistant TB, 68% were cured and 5% completed treatment, which was considered a successful TB treatment outcome. The rate of successful treatment was not significantly different in either HIV-infected or HIV-uninfected participants (P =.50).
In HIV-infected participants receiving concurrent antiretroviral therapy and multidrug-resistant TB treatment, mean CD4 counts at 12 and 24 months (321 and 386 cells/mm3, respectively) were significantly higher compared with baseline (215 cells/mm3). Furthermore, 64% of participants with HIV had an undetectable viral load.
Survival rates were not significantly different in HIV-infected and HIV-uninfected participants (86% vs 94%, respectively; P =.34). A CD4 count ≤100 cells/mm3 was associated with increased mortality risk (adjusted hazard ratio 15.6).
In an interview with Infectious Disease Advisor, James CM Brust, MD, associate professor of medicine in the divisions of general internal medicine and infectious diseases at Albert Einstein College of Medicine in New York explained that "until recently, it was unknown how best to manage multidrug-resistant TB in patients with HIV." Based on the results of this prospective study, Dr Brust concluded that "all patients with multidrug-resistant TB/HIV co-infection should be initiated on antiretroviral therapy if they are not already receiving it. Furthermore, such patients must be monitored closely and provided with patient-centered care to ensure high levels of treatment adherence, consistent virologic suppression, and immunological recovery."
Brust JCM, Shah NS, Mlisana K, et al. Improved survival and cure rates with concurrent treatment for MDR-TB/HIV co-infection in South Africa [published online December 26, 2017]. Clin Infect Dis. doi:10.1093/cid/cix1125