1921
Volume 75, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

The effects of HIV co-infection and multi-drug resistant tuberculosis (MDRTB) on tuberculosis prognosis are poorly defined. Therefore, we studied infectiousness and mortality of 287 tuberculosis patients treated with standard, directly observed, short-course therapy in the Peruvian community. During 6–17 months of treatment, 49 (18%) of patients died, of whom 48 (98%) had AIDS and 28 (57%) had MDRTB; 17/31 (55%) of MDRTB-patients with AIDS died within 2 months of diagnosis, before traditional susceptibility testing would have identified their MDRTB. Most non-MDRTB became smear- and culture-negative within 6 weeks of therapy, whereas most MDRTB remained sputum-culture-positive until death or treatment completion. HIV-negative patients with non-MDRTB had good outcomes. However, MDRTB was associated with prolonged infectiousness and HIV co-infection with early mortality, indicating a need for greater access to anti-retroviral therapy. Furthermore, early and rapid tuberculosis drug-susceptibility testing and infection control are required so that MDRTB can be appropriately treated early enough to reduce mortality and transmission.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.2006.75.1027
2006-12-01
2017-11-19
Loading full text...

Full text loading...

/deliver/fulltext/14761645/75/6/0751027.html?itemId=/content/journals/10.4269/ajtmh.2006.75.1027&mimeType=html&fmt=ahah

References

  1. Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, Raviglione MC, Dye C, 2003. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med 163 : 1009–1021.
  2. World Health Organisation, Global tuberculosis control: surveillance, planning, financing. WHO Report 2005. Geneva, 2006.
  3. Mukadi YD, Maher D, Harries A, 2001. Tuberculosis case fatality rates in high HIV prevalence populations in sub-Saharan Africa. AIDS 15 : 143–152.
  4. Espinal MA, Laszlo A, Simonsen L, Boulahbal F, Kim SJ, Reniero A, HoffnerS, Rieder HL, Binkin N, Dye C, Williams R, Raviglione MC, 2001. Global trends in resistance to antituberculosis drugs. World Health Organization-International Union against Tuberculosis and Lung Disease Working Group on Anti-Tuberculosis Drug Resistance Surveillance. N Engl J Med 344 : 1294–1303.
  5. Espinal MA, Kim SJ, Suarez PG, Kam KM, Khomenko AG, Migliori GB, Baez J, Kochi A, Dye C, Raviglione MC, 2000. Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcomes in 6 countries. JAMA 283 : 2537–2545.
  6. Behr MA, Warren SA, Salamon H, Hopewell PC, Ponce de Leon A, Daley CL, Small PM, 1999. Transmission of Mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli. Lancet 353 : 444–449.
  7. Anonymous, Tuberculosis en el Peru: informe anual, 2004. Lima, Peru: Direccion General de Salud de las Personas, Ministerio de Salud del Peru, 2005.
  8. Vasquez-Campos L, Asencios-Solis L, Leo-Hurtado E, Quispe-Torres N, Salazar-Lindo E, Bayona J, Becerra MC 2004. Drug resistance trends among previously treated tuberculosis patients in a national registry in Peru, 1994–2001. Int J Tuberc Lung Dis 8 : 465–472.
  9. Singh NP, Parija SC, 1998. The value of fluorescence microscopy of auramine-stained sputum smears for the diagnosis of pulmonary tuberculosis. Southeast Asian J Trop Med Public Health 29 : 860–863.
  10. Kubica K, Public health mycobacteriology: a guide for the level III laboratory. USDHHS: Centers for Disease Control, Atlanta, 1985.
  11. Caviedes L, Lee TS, Gilman RH, Sheen P, Spellman E, Lee EH, Berg DE, Montenegro-James S, 2000. Rapid, efficient detection and drug susceptibility testing of Mycobacterium tuberculosis in sputum by microscopic observation of broth cultures. The Tuberculosis Working Group in Peru. J Clin Microbiol 38 : 1203–1208.
  12. Moore DA, Mendoza D, Gilman RH, Evans CA, Hollm Delgado MG, Guerra J, Caviedes L, Vargas D, Ticona E, Ortiz J, Soto G, Serpa J, Tuberculosis Working Group in Peru, 2004. Microscopic observation drug susceptibility assay, a rapid, reliable diagnostic test for multidrug-resistant tuberculosis suitable for use in resource-poor settings. J Clin Microbiol 42 : 4432–4437.
  13. Franzblau SG, Witzig RS, McLaughlin JC, Torres P, Madico G, Hernandez A, Degnan MT, Cook MB, Quenzer VK, Ferguson RM Gilman RH, 1998. Rapid, low-technology MIC determination with clinical Mycobacterium tuberculosis isolates by using the microplate Alamar Blue assay. J Clin Microbiol 36 : 362–366.
  14. Telzak EE, Fazal BA, Pollard CL, Turett GS, Justman JE, Blum S, 1997. Factors influencing time to sputum conversion among patients with smear-positive pulmonary tuberculosis. Clin Infect Dis 25 : 666–670.
  15. Solis LA, Shin SS, Han LL, Llanos F, Stowell M, Sloutsky A, 2005. Validation of a rapid method for detection of M. tuberculosis resistance to isoniazid and rifampin in Lima, Peru. Int J Tuberc Lung Dis 9 : 760–764.
  16. El-Sadr WM, Perlman DC, Denning E, Matts JP, Cohn DL, 2001. A review of efficacy studies of 6-month short-course therapy for tuberculosis among patients infected with human immunodeficiency virus: differences in study outcomes. Clin Infect Dis 32 : 623–632.
  17. Fischl MA, Uttamchandani RB, Daikos GL, Poblete RB, Moreno JN, Reyes RR, Boota AM, Thompson LM, Cleary TJ, Lai S, 1992. An outbreak of tuberculosis caused by multiple-drug-resistant tubercle bacilli among patients with HIV infection. Ann Intern Med 117 : 177–183.
  18. Frieden TR, Sterling T, Pablos-Mendez A, Kilburn JO, Cauthen GM, Dooley SW, 1993. The emergence of drug-resistant tuberculosis in New York City. N Engl J Med 328 : 521–526.
  19. Fischl MA, Daikos GL, Uttamchandani RB, Poblete RB, Moreno JN, Reyes RR, Boota AM, Thompson LM, Cleary TJ, Oldham SA, et al., 1992. Clinical presentation and outcome of patients with HIV infection and tuberculosis caused by multiple-drug-resistant bacilli. Ann Intern Med 117 : 184–190.
  20. Tuberculosis en el Peru: informe 2000. Publication 9972-776-12-3 ed. Lima, Peru: Direccion General de Salud de las Personas, Ministerio de Salud del Peru, 2001.
  21. Tuberculosis en el Peru: informe 1999. Lima, Peru: Direccion General de Salud de las Personas, Ministerio de Salud del Peru, 2000.
  22. Kramer F, Modilevsky T, Waliany AR, Leedom JM, Barnes PF, 1990. Delayed diagnosis of tuberculosis in patients with human immunodeficiency virus infection. Am J Med 89 : 451–456.
  23. Pablos-Mendez A, Sterling TR, Frieden TR, 1996. The relationship between delayed or incomplete treatment and all-cause mortality in patients with tuberculosis. JAMA 276 : 1223–1228.
  24. Kirk O, Gatell JM, Mocroft A, Pedersen C, Proenca R, Brettle RP, Barton SE, Sudre P, Phillips AN, 2000. Infections with Mycobacterium tuberculosis and Mycobacterium avium among HIV-infected patients after the introduction of highly active antiretroviral therapy. EuroSIDA Study Group JD. Am J Respir Crit Care Med 162 : 865–872.
  25. Long R, Bochar K, Chomyc S, Talbot J, Barrie J, Kunimoto D, Tilley P, 2003. Relative versus absolute noncontagiousness of respiratory tuberculosis on treatment. Infect Control Hosp Epidemiol 24 : 831–838.
  26. Sanghavi DM, Gilman RH, Lescano-Guevara AG, Checkley W, Cabrera LZ, Cardenas V, 1998. Hyperendemic pulmonary tuberculosis in a Peruvian shantytown. Am J Epidemiol 148 : 384–389.
  27. Madico G, Gilman RH, Checkley W, Cabrera L, Kohlstadt I, Kacena K, Diaz JF, Black R, 1995. Community infection ratio as an indicator for tuberculosis control. Lancet 345 : 416–419.
  28. Getchell WS, Davis CE, Gilman J, Urueta G, Ruiz-Huidobro E, Gilman RH, 1992. Basic epidemiology of tuberculosis in Peru: a prevalence study of tuberculin sensitivity in a Pueblo joven. Am J Trop Med Hyg 47 : 721–729.
  29. Suarez PG, Watt CJ, Alarcon E, Portocarrero J, Zavala D, Canales R, Luelmo F, Espinal MA, Dye C, 2001. The dynamics of tuberculosis in response to 10 years of intensive control effort in Peru. J Infect Dis 184 : 473–478.
  30. Campos PE, Suarez PG, Sanchez J, Zavala D, Arevalo J, Ticona E, Nolan CM, Hooton TM, Holmes KK, 2003. Multidrug-resistant Mycobacterium tuberculosis in HIV-infected persons, Peru. Emerg Infect Dis 9 : 1571–1578.
  31. Singla R, Al-Sharif N, Al-Sayegh MO, Osman MM, Shaikh MA, 2002. Influence of anti-tuberculosis drug resistance on the treatment outcome of pulmonary tuberculosis patients receiving DOTS in Riyadh, Saudi Arabia. Int J Tuberc Lung Dis 6 : 585–591.
  32. Bonnet M, Sizaire V, Kebede Y, Janin A, Doshetov D, Mirzoian B, Arzumanian A, Muminov T, Iona E, Rigouts L, Rusch-Gerdes S, Varaine F, 2005. Does one size fit all? Drug resistance and standard treatments: results of six tuberculosis programmes in former Soviet countries. Int J Tuberc Lung Dis 9 : 1147–1154.
  33. DeRiemer K, Garcia-Garcia L, Bobadilla-del-Valle M, Palacios-Martinez M, Martinez-Gamboa A, Small PM, Sifuentes-Osornio J, Ponce-de-Leon A, 2005. Does DOTS work in populations with drug-resistant tuberculosis? Lancet 365 : 1239–1245.
  34. Mitnick C, Bayona J, Palacios E, Shin S, Furin J, Alcantara F, Sanchez E, Sarria M, Becerra M, Fawzi MC, Kapiga S, Neuberg D, Maguire JH, Kim JY, Farmer P, 2003. Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med 348 : 119–128.
  35. Becerra MC, Freeman J, Boyona J, Shin SS, Kim JY, Furin JJ, Werner B, Sloutsky A, Timperi R, Wilson ME, Pagano M, Farmer PE, 2000. Using treatment failure under effective directly observed short-course chemotherapy programs to identify patients with multidrug resistant tuberculosis. Int J Tuberc Lung Dis 4 : 108–114.
  36. Suarez PG, Floyd K, Portocarrero J, Alarcon E, Rapiti E, Ramos G, Bonilla C, Sabogal I, Aranda I, Dye C, Raviglione M, Espinal MA, 2002. Feasibility and cost-effectiveness of standardised second-line drug treatment for chronic tuberculosis patients: a national cohort study in Peru. Lancet 359 : 1980–1989.
  37. Anonymous, Norma Tecnica de Salud para el Control de la Tuberculosis. Lima, Peru: Direccion General de Salud de las Personas, Ministerio de Salud del Peru, 2006.
  38. Hawken MP, Meme HK, Elliott LC, Chakaya JM, Morris JS, Githui WA, Juma ES, Odhiambo JA, Thiong’o LN, Kimari JN, Ngugi EN, Bwayo JJ, Gilks CF, Plummer FA, Porter JD, Nunn PP, McAdam KP, 1997. Isoniazid preventive therapy for tuberculosis in HIV-1-infected adults: results of a randomized controlled trial. AIDS 11 : 875–882.
  39. Gordin F, Chaisson RE, Matts JP, Miller C, de Lourdes Garcia M, Hafner R, Valdespino JL, Coberly J, Schechter M, Klukowicz AJ, Barry MA, O’Brien RJ, 2000. Rifampin and pyrazinamide vs isoniazid for prevention of tuberculosis in HIV-infected persons: an international randomized trial. Terry Beirn Community Programs for Clinical Research on AIDS, the Adult AIDS Clinical Trials Group, the Pan American Health Organization, and the Centers for Disease Control and Prevention Study Group. JAMA 283 : 1445–1450.
  40. Hanson ML, Comstock GW, Haley CE, 1967. Community isoniazid prophylaxis program in an underdeveloped area of Alaska. Public Health Rep 82 : 1045–1056.
  41. Burman WJ, Reves RR, 2000. Review of false-positive cultures for Mycobacterium tuberculosis and recommendations for avoiding unnecessary treatment. Clin Infect Dis 31 : 1390–1395.
  42. Farmer P, Kim JY, 1998. Community-based approaches to the control of multidrug resistant tuberculosis: introducing DOTS-plus. BMJ 317 : 671–674.
  43. Furin JJ, Becerra MC, Shin SS, Kim JY, Bayona J, Farmer PE, 2000. Effect of administering short-course, standardized regimens in individuals infected with drug-resistant Mycobacterium tuberculosis strains. Eur J Clin Microbiol Infect Dis 19 : 132–136.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2006.75.1027
Loading
/content/journals/10.4269/ajtmh.2006.75.1027
Loading

Data & Media loading...

  • Received : 01 Mar 2006
  • Accepted : 14 Jun 2006

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error