Predictors of Rifampicin-Resistant Tuberculosis Mortality among HIV-Coinfected Patients in Rwanda

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  • 1 HIV, AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda;
  • 2 National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda;
  • 3 Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium;
  • 4 Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium;
  • 5 Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda;
  • 6 Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda;
  • 7 Department of Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda;
  • 8 Rwanda Biomedical Centre, Kigali, Rwanda;
  • 9 Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium;
  • 10 Research Foundation Flanders, Brussels, Belgium

Tuberculosis (TB), including multidrug-resistant (MDR; i.e., resistant to at least rifampicin and isoniazid)/rifampicin-resistant (MDR/RR) TB, is the most important opportunistic infection among people living with HIV (PLHIV). In 2005, Rwanda launched the programmatic management of MDR/RR-TB. The shorter MDR/RR-TB treatment regimen (STR) has been implemented since 2014. We analyzed predictors of MDR/RR-TB mortality, including the effect of using the STR overall and among PLHIV. This retrospective study included data from patients diagnosed with RR-TB in Rwanda between July 2005 and December 2018. Multivariable logistic regression was used to assess predictors of mortality. Of 898 registered MDR/RR-TB patients, 861 (95.9%) were included in this analysis, of whom 360 (41.8%) were HIV coinfected. Overall, 86 (10%) patients died during MDR/RR-TB treatment. Mortality was higher among HIV-coinfected compared with HIV-negative TB patients (13.3% versus 7.6%). Among HIV-coinfected patients, patients aged ≥ 55 years (adjusted odds ratio = 5.89) and those with CD4 count ≤ 100 cells/mm3 (adjusted odds ratio = 3.77) had a higher likelihood of dying. Using either the standardized longer MDR/RR-TB treatment regimen or the STR was not correlated with mortality overall or among PLHIV. The STR was as effective as the long MDR/RR-TB regimen. In conclusion, older age and advanced HIV disease were strong predictors of MDR/RR-TB mortality. Therefore, special care for elderly and HIV-coinfected patients with ≤ 100 CD4 cells/mL might further reduce MDR/RR-TB mortality.

Author Notes

Address correspondence to Dominique Savio Habimana, HIV, AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, PO Box 7268, 20093 Kigali, Rwanda. E-mail: habsav2@gmail.com

Authors’ addresses: Dominique Savio Habimana, Eric Remera, and Placidie Mugwaneza, HIV, AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda, E-mails: habsav2@gmail.com, ericremera@gmail.com, and muplacy@gmail.com. Jean Claude Semuto Ngabonziza, National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda, Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium, and Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium, E-mail: jclaude.ngabonziza@rbc.gov.rw. Patrick Migambi, Yves Mucyo-Habimana, Grace Mutembayire, Francine Byukusenge, and Innocent Habiyambere, Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda, E-mails: patrick.migambi@rbc.gov.rw, yves.mucyo@rbc.gov.rw, graceyire@yahoo.fr, fbyukusenge82@gmail.com, and innocent.habiyambere@rbc.gov.rw. Ivan Emil Mwikarago, National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Centre, Kigali, Rwanda, E-mail: ivan.mwikarago@rbc.gov.rw. Innocent Turate, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda, E-mail: innocent.turate@rbc.gov.rw. Jean Baptiste Mazarati, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda, E-mail: jbaptiste.mazarati@rbc.gov.rw. Sabin Nsanzimana, Rwanda Biomedical Centre, Kigali, Rwanda, E-mail: sabin.nsanzimana@rbc.gov.rw.Tom Decroo, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium, and Research Foundation Flanders, Brussels, Belgium, E-mail: tdecroo@itg.be. Catherine Bouke de Jong, Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium, E-mail: bdejong@itg.be.

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