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Article ; Online: Systematic, Point-of-Care Urine Lipoarabinomannan (Alere TB-LAM) Assay for Diagnosing Tuberculosis in Severely Immunocompromised HIV-Positive Ambulatory Patients.

Huerga, Helena / Cossa, Loide / Manhiça, Ivan / Bastard, Mathieu / Telnov, Alex / Molfino, Lucas / Sanchez-Padilla, Elisabeth

The American journal of tropical medicine and hygiene

2020 Volume 102, Issue 3, Page(s) 562–566

Abstract: Point-of-care urine-lipoarabinomannan (LAM) Alere Determine TB-LAM assay has shown utility diagnosing tuberculosis (TB) in HIV-positive, severely immunocompromised, TB-symptomatic patients. We assessed LAM results in severely immunocompromised patients, ... ...

Abstract	Point-of-care urine-lipoarabinomannan (LAM) Alere Determine TB-LAM assay has shown utility diagnosing tuberculosis (TB) in HIV-positive, severely immunocompromised, TB-symptomatic patients. We assessed LAM results in severely immunocompromised patients, who had LAM systematically performed at new or follow-up HIV consultations. This was a prospective, observational study on consecutive ambulatory, > 15-year-old HIV-positive patients with CD4 < 100 cells/µL in Mozambique. Clinical assessments and LAM were performed for all and microscopy, Xpert, sputum culture, and chest X-ray for LAM-positive participants. Patients were followed up for 6 months. Of 360 patients, half were ART-naive. Lipoarabinomannan positivity was 11.9% (43/360), higher among symptomatic patients compared with asymptomatic: 18.5% (30/162), and 6.6% (13/198), respectively,
MeSH term(s)	Adult ; Female ; HIV Infections/complications ; HIV Infections/pathology ; HIV Infections/urine ; HIV-1 ; Humans ; Immunocompromised Host ; Lipopolysaccharides/urine ; Male ; Point-of-Care Testing ; Tuberculosis/complications ; Tuberculosis/diagnosis ; Tuberculosis/urine ; Urinalysis/methods
Chemical Substances	Lipopolysaccharides ; lipoarabinomannan
Language	English
Publishing date	2020-01-23
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.19-0493
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Article: Outcomes of AIDS-associated Kaposi sarcoma in Mozambique after treatment with pegylated liposomal doxorubicin.

Coldiron, Matthew E / Gutierrez Zamudio, Ana Gabriela / Manuel, Rolanda / Luciano, Gilda / Rusch, Barbara / Ciglenecki, Iza / Telnov, Alex / Grais, Rebecca F / Trellu, Laurence Toutous / Molfino, Lucas

Infectious agents and cancer

2021 Volume 16, Issue 1, Page(s) 2

Abstract: Background: Kaposi's sarcoma (KS) is a common HIV-associated malignancy frequently associated with poor outcomes. It is the most frequently diagnosed cancer in major cities of Mozambique. Antiretroviral therapy is the cornerstone of KS treatment, but ... ...

Abstract	Background: Kaposi's sarcoma (KS) is a common HIV-associated malignancy frequently associated with poor outcomes. It is the most frequently diagnosed cancer in major cities of Mozambique. Antiretroviral therapy is the cornerstone of KS treatment, but many patients require cytotoxic chemotherapy. The traditional regimen in Mozambique includes conventional doxorubicin, bleomycin and vincristine, which is poorly tolerated. In 2016, pegylated liposomal doxorubicin was introduced at a specialized outpatient center in Maputo, Mozambique. Methods: We performed a prospective, single-arm, open-label observational study to demonstrate the feasibility, safety, and outcomes of treatment with pegylated liposomal doxorubicin (PLD) in patients with AIDS-associated Kaposi sarcoma (KS) in a low-resource setting. Chemotherapy-naïve adults with AIDS-associated KS (T1 or T0 not responding to 6 months of antiretroviral therapy) were eligible if they were willing to follow up for 2 years. Patients with Karnofsky scores < 50 or contraindications to PLD were excluded. One hundred eighty-three patients were screened and 116 participants were enrolled. Patients received PLD on three-week cycles until meeting clinical stopping criteria. Follow-up visits monitored HIV status, KS disease, side effects of chemotherapy, mental health (PHQ-9) and quality of life (SF-12). Primary outcome measures included vital status and disease status at 6, 12, and 24 months after enrollment. Results: At 24 months, 23 participants (20%) had died and 15 (13%) were lost to follow-up. Baseline CD4 < 100 was associated with death (HR 2.7, 95%CI [1.2-6.2], p = 0.016), as was T1S1 disease compared to T1S0 disease (HR 2.7, 95%CI [1.1-6.4], p = 0.023). Ninety-two participants achieved complete or partial remission at any point (overall response rate 80%), including 15 (13%) who achieved complete remission. PLD was well-tolerated, and the most common AEs were neutropenia and anemia. Quality of life improved rapidly after beginning PLD. Discussion: PLD was safe, well-tolerated and effective as first-line treatment of KS in Mozambique. High mortality was likely due to advanced immunosuppression at presentation, underscoring the importance of earlier screening and referral for KS.
Language	English
Publishing date	2021-01-07
Publishing country	England
Document type	Journal Article
ISSN	1750-9378
ISSN	1750-9378
DOI	10.1186/s13027-020-00341-4
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Article ; Online: Programmatic outcomes and impact of rapid public sector antiretroviral therapy expansion in adults prior to introduction of the WHO treat-all approach in rural Eswatini.

Kerschberger, Bernhard / Schomaker, Michael / Ciglenecki, Iza / Pasipamire, Lorraine / Mabhena, Edwin / Telnov, Alex / Rusch, Barbara / Lukhele, Nomthandazo / Teck, Roger / Boulle, Andrew

Tropical medicine & international health : TM & IH

2019 Volume 24, Issue 6, Page(s) 701–714

Abstract: Objectives: To assess long-term antiretroviral therapy (ART) outcomes during rapid HIV programme expansion in the public sector of Eswatini (formerly Swaziland).: Methods: This is a retrospectively established cohort of HIV-positive adults (≥16 years) ...

Abstract	Objectives: To assess long-term antiretroviral therapy (ART) outcomes during rapid HIV programme expansion in the public sector of Eswatini (formerly Swaziland). Methods: This is a retrospectively established cohort of HIV-positive adults (≥16 years) who started first-line ART in 25 health facilities in Shiselweni (Eswatini) between 01/2006 and 12/2014. Temporal trends in ART attrition, treatment expansion and ART coverage were described over 9 years. We used flexible parametric survival models to assess the relationship between time to ART attrition and covariates. Results: Of 24 772 ART initiations, 6% (n = 1488) occurred in 2006, vs. 13% (n = 3192) in 2014. Between these years, median CD4 cell count at ART initiation increased (113-265 cells/mm Conclusions: Programmatic outcomes improved during large expansion of the treatment cohort and increased ART coverage. Changes in ART programming may have contributed to better outcomes.
MeSH term(s)	Adult ; Anti-HIV Agents/administration & dosage ; Anti-HIV Agents/therapeutic use ; CD4 Lymphocyte Count ; Eligibility Determination ; Eswatini ; Female ; HIV Infections/drug therapy ; Humans ; Kaplan-Meier Estimate ; Male ; Medication Adherence/statistics & numerical data ; Middle Aged ; Multivariate Analysis ; Pregnancy ; Program Evaluation ; Proportional Hazards Models ; Public Sector/statistics & numerical data ; Retrospective Studies ; Rural Population ; Time-to-Treatment/statistics & numerical data
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2019-04-01
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	1314080-2
ISSN	1365-3156 ; 1360-2276
ISSN (online)	1365-3156
ISSN	1360-2276
DOI	10.1111/tmi.13234
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Article ; Online: Predicting, Diagnosing, and Treating Acute and Early HIV Infection in a Public Sector Facility in Eswatini.

Kerschberger, Bernhard / Aung, Aung / Mpala, Qhubekani / Ntshalintshali, Nombuso / Mamba, Charlie / Schomaker, Michael / Tombo, Marie Luce / Maphalala, Gugu / Sibandze, Dumile / Dube, Lenhle / Kashangura, Rufaro / Mthethwa-Hleza, Simangele / Telnov, Alex / Tour, Roberto de la / Gonzalez, Alan / Calmy, Alexandra / Ciglenecki, Iza

Journal of acquired immune deficiency syndromes (1999)

2021 Volume 88, Issue 5, Page(s) 506–517

Abstract: Background: The lack of acute and early HIV infection (AEHI) diagnosis and care contributes to high HIV incidence in resource-limited settings. We aimed to assess the yield of AEHI, predict and diagnose AEHI, and describe AEHI care outcomes in a public ... ...

Abstract	Background: The lack of acute and early HIV infection (AEHI) diagnosis and care contributes to high HIV incidence in resource-limited settings. We aimed to assess the yield of AEHI, predict and diagnose AEHI, and describe AEHI care outcomes in a public sector setting in Eswatini. Setting: This study was conducted in Nhlangano outpatient department from March 2019 to March 2020. Methods: Adults at risk of AEHI underwent diagnostic testing for AEHI with the quantitative Xpert HIV-1 viral load (VL) assay. AEHI was defined as the detection of HIV-1 VL on Xpert and either an HIV-seronegative or HIV-serodiscordant third-generation antibody-based rapid diagnostic test (RDT) result. First, the cross-sectional analysis obtained the yield of AEHI and established a predictor risk score for the prediction of AEHI using Lasso logistic regression. Second, diagnostic accuracy statistics described the ability of the fourth-generation antibody/p24 antigen-based Alere HIV-Combo RDT to diagnose AEHI (vs Xpert VL testing). Third, we described acute HIV infection care outcomes of AEHI-positive patients using survival analysis. Results: Of 795 HIV-seronegative/HIV-serodiscordant outpatients recruited, 30 (3.8%, 95% confidence interval: 2.6% to 5.3%) had AEHI. The predictor risk score contained several factors (HIV-serodiscordant RDT, women, feeling at risk of HIV, swollen glands, and fatigue) and had sensitivity and specificity of 83.3% and 65.8%, respectively, to predict AEHI. The HIV-Combo RDT had sensitivity and specificity of 86.2% and 99.9%, respectively, to diagnose AEHI. Of 30 AEHI-positive patients, the 1-month cumulative treatment initiation was 74% (95% confidence interval: 57% to 88%), and the 3-month viral suppression (<1000 copies/mL) was 87% (67% to 98%). Conclusion: AEHI diagnosis and care seem possible in resource-limited settings.
MeSH term(s)	Acute Disease ; Adult ; Anti-Retroviral Agents/therapeutic use ; Cross-Sectional Studies ; Early Diagnosis ; Eswatini/epidemiology ; Female ; HIV Antibodies/blood ; HIV Core Protein p24 ; HIV Infections/diagnosis ; HIV Infections/drug therapy ; HIV-1/immunology ; Humans ; Predictive Value of Tests ; Public Sector ; Sensitivity and Specificity ; Time Factors
Chemical Substances	Anti-Retroviral Agents ; HIV Antibodies ; HIV Core Protein p24
Language	English
Publishing date	2021-08-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	645053-2
ISSN	1944-7884 ; 1077-9450 ; 0897-5965 ; 0894-9255 ; 1525-4135
ISSN (online)	1944-7884 ; 1077-9450
ISSN	0897-5965 ; 0894-9255 ; 1525-4135
DOI	10.1097/QAI.0000000000002794
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Article ; Online: Treatment Outcomes of Patients Switching From an Injectable Drug to Bedaquiline During Short Standardized Treatment for Multidrug-resistant Tuberculosis in Mozambique.

Bastard, Mathieu / Molfino, Lucas / Mutaquiha, Cláudia / Galindo, Miriam Arago / Zindoga, Pereira / Vaz, Deise / Mahinça, Ivan / DuCros, Philipp / Rusch, Barbara / Telnov, Alex

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2019 Volume 69, Issue 10, Page(s) 1809–1811

Abstract: Bedaquiline was recommended by the World Health Organization as the preferred option in treatment of multidrug-resistant tuberculosis (MDR-TB) with long regimens. However, no recommendation was given for the short MDR-TB regimen. Data from our small ... ...

Abstract	Bedaquiline was recommended by the World Health Organization as the preferred option in treatment of multidrug-resistant tuberculosis (MDR-TB) with long regimens. However, no recommendation was given for the short MDR-TB regimen. Data from our small cohort of patients who switched from injectable drug to bedaquiline suggest that a bedaquiline-based short regimen is effective and safe.
MeSH term(s)	Adult ; Antitubercular Agents/administration & dosage ; Diarylquinolines/administration & dosage ; Drug Administration Routes ; Drug Administration Schedule ; Drug Substitution ; Female ; Humans ; Injections ; Kanamycin/adverse effects ; Kanamycin/therapeutic use ; Male ; Middle Aged ; Mozambique/epidemiology ; Treatment Outcome ; Tuberculosis, Multidrug-Resistant/drug therapy ; Tuberculosis, Multidrug-Resistant/epidemiology
Chemical Substances	Antitubercular Agents ; Diarylquinolines ; Kanamycin (59-01-8) ; bedaquiline (78846I289Y)
Language	English
Publishing date	2019-03-18
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciz196
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Article ; Online: Diagnostic value of the urine lipoarabinomannan assay in HIV-positive, ambulatory patients with CD4 below 200 cells/μl in 2 low-resource settings: A prospective observational study.

Huerga, Helena / Mathabire Rucker, Sekai Chenai / Cossa, Loide / Bastard, Mathieu / Amoros, Isabel / Manhiça, Ivan / Mbendera, Kuzani / Telnov, Alex / Szumilin, Elisabeth / Sanchez-Padilla, Elisabeth / Molfino, Lucas

PLoS medicine

2019 Volume 16, Issue 4, Page(s) e1002792

Abstract: Background: Current guidelines recommend the use of the lateral flow urine lipoarabinomannan assay (LAM) in HIV-positive, ambulatory patients with signs and symptoms of tuberculosis (TB) only if they are seriously ill or have CD4 count ≤ 100 cells/μl. ... ...

Abstract	Background: Current guidelines recommend the use of the lateral flow urine lipoarabinomannan assay (LAM) in HIV-positive, ambulatory patients with signs and symptoms of tuberculosis (TB) only if they are seriously ill or have CD4 count ≤ 100 cells/μl. We assessed the diagnostic yield of including LAM in TB diagnostic algorithms in HIV-positive, ambulatory patients with CD4 < 200 cells/μl, as well as the risk of mortality in LAM-positive patients who were not diagnosed using other diagnostic tools and not treated for TB. Methods and findings: We conducted a prospective observational study including HIV-positive adult patients with signs and symptoms of TB and CD4 < 200 cells/μl attending 6 health facilities in Malawi and Mozambique. Patients were included consecutively from 18 September 2015 to 27 October 2016 in Malawi and from 3 December 2014 to 22 August 2016 in Mozambique. All patients had a clinical exam and LAM, chest X-ray, sputum microscopy, and Xpert MTB/RIF assay (Xpert) requested. Culture in sputum was done for a subset of patients. The diagnostic yield was defined as the proportion of patients with a positive assay result among those with laboratory-confirmed TB. For the 456 patients included in the study, the median age was 36 years (IQR 31-43) and the median CD4 count was 50 cells/μl (IQR 21-108). Forty-five percent (205/456) of the patients had laboratory-confirmed TB. The diagnostic yields of LAM, microscopy, and Xpert were 82.4% (169/205), 33.7% (69/205), and 40.0% (84/205), respectively. In total, 50.2% (103/205) of the patients with laboratory-confirmed TB were diagnosed only through LAM. Overall, the use of LAM in diagnostic algorithms increased the yield of algorithms with microscopy and with Xpert by 38.0% (78/205) and 34.6% (71/205), respectively, and, specifically among patients with CD4 100-199 cells/μl, by 27.5% (14/51) and 29.4% (15/51), respectively. LAM-positive patients not diagnosed through other tools and not treated for TB had a significantly higher risk of mortality than LAM-positive patients who received treatment (adjusted risk ratio 2.57, 95% CI 1.27-5.19, p = 0.009). Although the TB diagnostic conditions in the study sites were similar to those in other resource-limited settings, the added value of LAM may depend on the availability of microscopy or Xpert results. Conclusions: LAM has diagnostic value for identifying TB in HIV-positive patients with signs and symptoms of TB and advanced immunodeficiency, including those with a CD4 count of 100-199 cells/μl. In this study, the use of LAM enabled the diagnosis of TB in half of the patients with confirmed TB disease; without LAM, these patients would have been missed. The rapid identification and treatment of TB enabled by LAM may decrease overall mortality risk for these patients.
MeSH term(s)	Adult ; Ambulatory Care Facilities ; CD4 Lymphocyte Count ; Coinfection/diagnosis ; Coinfection/urine ; Female ; HIV Infections/blood ; HIV Infections/complications ; HIV Infections/diagnosis ; HIV Infections/urine ; HIV Seropositivity/blood ; HIV Seropositivity/complications ; HIV Seropositivity/urine ; Health Resources ; Humans ; Lipopolysaccharides/urine ; Malawi ; Male ; Mozambique ; Point-of-Care Systems ; Poverty Areas ; Predictive Value of Tests ; Sensitivity and Specificity ; Tuberculosis/blood ; Tuberculosis/complications ; Tuberculosis/diagnosis ; Tuberculosis/urine ; Urinalysis/economics ; Urinalysis/methods
Chemical Substances	Lipopolysaccharides ; lipoarabinomannan
Language	English
Publishing date	2019-04-30
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2185925-5
ISSN	1549-1676 ; 1549-1277
ISSN (online)	1549-1676
ISSN	1549-1277
DOI	10.1371/journal.pmed.1002792
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Article ; Online: Decreased risk of HIV-associated TB during antiretroviral therapy expansion in rural Eswatini from 2009 to 2016: a cohort and population-based analysis.

Kerschberger, Bernhard / Schomaker, Michael / Telnov, Alex / Vambe, Debrah / Kisyeri, Nicholas / Sikhondze, Welile / Pasipamire, Lorraine / Ngwenya, Siphiwe Mavis / Rusch, Barbara / Ciglenecki, Iza / Boulle, Andrew

Tropical medicine & international health : TM & IH

2019 Volume 24, Issue 9, Page(s) 1114–1127

Abstract: Objectives: This paper assesses patient- and population-level trends in TB notifications during rapid expansion of antiretroviral therapy in Eswatini which has an extremely high incidence of both TB and HIV.: Methods: Patient- and population-level ... ...

Abstract	Objectives: This paper assesses patient- and population-level trends in TB notifications during rapid expansion of antiretroviral therapy in Eswatini which has an extremely high incidence of both TB and HIV. Methods: Patient- and population-level predictors and rates of HIV-associated TB were examined in the Shiselweni region in Eswatini from 2009 to 2016. Annual population-level denominators obtained from projected census data and prevalence estimates obtained from population-based surveys were combined with individual-level TB treatment data. Patient- and population-level predictors of HIV-associated TB were assessed with multivariate logistic and multivariate negative binomial regression models. Results: Of 11 328 TB cases, 71.4% were HIV co-infected and 51.8% were women. TB notifications decreased fivefold between 2009 and 2016, from 1341 to 269 cases per 100 000 person-years. The decline was sixfold in PLHIV vs. threefold in the HIV-negative population. Main patient-level predictors of HIV-associated TB were recurrent TB treatment (adjusted odds ratio [aOR] 1.40, 95% confidence interval [CI]: 1.19-1.65), negative (aOR 1.31, 1.15-1.49) and missing (aOR 1.30, 1.11-1.53) bacteriological status and diagnosis at secondary healthcare level (aOR 1.18, 1.06-1.33). Compared with 2009, the probability of TB decreased for all years from 2011 (aOR 0.69, 0.58-0.83) to 2016 (aOR 0.54, 0.43-0.69). The most pronounced population-level predictor of TB was HIV-positive status (adjusted incidence risk ratio 19.47, 14.89-25.46). Conclusions: This high HIV-TB prevalence setting experienced a rapid decline in TB notifications, most pronounced in PLHIV. Achievements in HIV-TB programming were likely contributing factors.
MeSH term(s)	Adolescent ; Adult ; Age Factors ; Anti-HIV Agents/therapeutic use ; Eswatini ; Female ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Humans ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Risk Factors ; Sex Factors ; Tuberculosis/epidemiology ; Young Adult
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2019-08-07
Publishing country	England
Document type	Journal Article
ZDB-ID	1314080-2
ISSN	1365-3156 ; 1360-2276
ISSN (online)	1365-3156
ISSN	1360-2276
DOI	10.1111/tmi.13290
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Article ; Online: Successful expansion of community-based drug-resistant TB care in rural Eswatini - a retrospective cohort study.

Kerschberger, Bernhard / Telnov, Alex / Yano, Nanako / Cox, Helen / Zabsonre, Inoussa / Kabore, Serge Mathurin / Vambe, Debrah / Ngwenya, Siphiwe / Rusch, Barbara / Tombo, Marie Luce / Ciglenecki, Iza

Tropical medicine & international health : TM & IH

2019 Volume 24, Issue 10, Page(s) 1243–1258

Abstract: Objectives: Provision of drug-resistant tuberculosis (DR-TB) treatment is scarce in resource-limited settings. We assessed the feasibility of ambulatory DR-TB care for treatment expansion in rural Eswatini.: Methods: Retrospective patient-level data ... ...

Abstract	Objectives: Provision of drug-resistant tuberculosis (DR-TB) treatment is scarce in resource-limited settings. We assessed the feasibility of ambulatory DR-TB care for treatment expansion in rural Eswatini. Methods: Retrospective patient-level data were used to evaluate ambulatory DR-TB treatment provision in rural Shiselweni (Eswatini), from 2008 to 2016. DR-TB care was either clinic-based led by nurses or community-based at the patient's home with involvement of community treatment supporters for provision of treatment to patients with difficulties in accessing facilities. We describe programmatic outcomes and used multivariate flexible parametric survival models to assess time to adverse outcomes. Both care models were costed in supplementary analyses. Results: Of 698 patients initiated on DR-TB treatment, 57% were women and 84% were HIV-positive. Treatment initiations increased from 27 in 2008 to 127 in 2011 and decreased thereafter to 51 in 2016. Proportionally, community-based care increased from 19% in 2009 to 77% in 2016. Treatment success was higher for community-based care (79%) than clinic-based care (68%, P = 0.002). After adjustment for covariate factors among adults (n = 552), the risk of adverse outcomes (death, loss to follow-up, treatment failure) in community-based care was reduced by 41% (adjusted hazard ratio 0.59, 95% CI: 0.39-0.91). Findings were supported by sensitivity analyses. The care provider's per-patient costs for community-based (USD13 345) and clinic-based (USD12 990) care were similar. Conclusions: Ambulatory treatment outcomes were good, and community-based care achieved better treatment outcomes than clinic-based care at comparable costs. Contextualised DR-TB care programmes are feasible and can support treatment expansion in rural settings.
MeSH term(s)	Adolescent ; Adult ; Ambulatory Care/methods ; Antitubercular Agents/therapeutic use ; Child ; Child, Preschool ; Cohort Studies ; Community Health Services/methods ; Eswatini ; Feasibility Studies ; Female ; Humans ; Infant ; Male ; Middle Aged ; Retrospective Studies ; Rural Population ; Treatment Outcome ; Tuberculosis, Multidrug-Resistant/drug therapy ; Young Adult
Chemical Substances	Antitubercular Agents
Language	English
Publishing date	2019-08-27
Publishing country	England
Document type	Journal Article
ZDB-ID	1314080-2
ISSN	1365-3156 ; 1360-2276
ISSN (online)	1365-3156
ISSN	1360-2276
DOI	10.1111/tmi.13299
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Article ; Online: Outcomes of HIV-infected versus HIV-non-infected patients treated for drug-resistance tuberculosis: Multicenter cohort study.

Bastard, Mathieu / Sanchez-Padilla, Elisabeth / du Cros, Philipp / Khamraev, Atadjan Karimovich / Parpieva, Nargiza / Tillyashaykov, Mirzagaleg / Hayrapetyan, Armen / Kimenye, Kamene / Khurkhumal, Shazina / Dlamini, Themba / Perez, Santiago Fadul / Telnov, Alex / Hewison, Cathy / Varaine, Francis / Bonnet, Maryline

PloS one

2018 Volume 13, Issue 3, Page(s) e0193491

Abstract: Background: The emergence of resistance to anti-tuberculosis (DR-TB) drugs and the HIV epidemic represent a serious threat for reducing the global burden of TB. Although data on HIV-negative DR-TB treatment outcomes are well published, few data on DR-TB ...

Abstract	Background: The emergence of resistance to anti-tuberculosis (DR-TB) drugs and the HIV epidemic represent a serious threat for reducing the global burden of TB. Although data on HIV-negative DR-TB treatment outcomes are well published, few data on DR-TB outcomes among HIV co-infected people is available despite the great public health importance. Methods: We retrospectively reported and compared the DR-TB treatment outcomes of HIV-positive and HIV-negative patients treated with an individualized regimen based on WHO guidelines in seven countries: Abkhazia, Armenia, Colombia, Kenya, Kyrgyzstan, Swaziland and Uzbekistan. Results: Of the 1,369 patients started DRTB treatment, 809 (59.1%) were multi-drug resistant (MDR-TB) and 418 (30.5%) were HIV-positive. HIV-positive patients were mainly from African countries (90.1%) while HIV-negative originated from Former Soviet Union (FSU) countries. Despite a higher case fatality rate (19.0% vs 9.4%), HIV-positive MDR-TB patients had a 10% higher success rate than HIV-negative patients (64.0% vs 53.2%, p = 0.007). No difference in treatment success was found among polydrug-resistant (PDR-TB) patients. Overall, lost to follow-up rate was much higher among HIV-negative (22.0% vs. 8.4%). Older age and not receiving ART were the only factors associated with unfavorable treatment outcome among HIV-positive patients. Conclusions: As already known for HIV-negative patients, success rate of DR-TB HIV-positive patients remains low and requires more effective DR-TB regimen using new drugs also suitable to HIV-infected patients on ART. The study also confirms the need of ART introduction in HIV co-infected patients.
MeSH term(s)	Adult ; Africa/epidemiology ; Antitubercular Agents/therapeutic use ; Asia, Central/epidemiology ; Coinfection/drug therapy ; Coinfection/epidemiology ; Colombia/epidemiology ; Female ; Follow-Up Studies ; HIV Infections/complications ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Transcaucasia/epidemiology ; Treatment Outcome ; Tuberculosis, Multidrug-Resistant/complications ; Tuberculosis, Multidrug-Resistant/drug therapy ; Tuberculosis, Multidrug-Resistant/epidemiology
Chemical Substances	Antitubercular Agents
Language	English
Publishing date	2018
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Multicenter Study
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0193491
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Article ; Online: Reply: How Do the New Definitions for Multidrug-Resistant Tuberculosis Treatment Outcomes Really Perform?

Bastard, Mathieu / Bonnet, Maryline / du Cros, Philipp / Khamraev, Atadjan Karimovich / Hayrapetyan, Armen / Kimenye, Kamene / Khurkhumal, Shazina / Dlamini, Themba / Telnov, Alex / Sanchez-Padilla, Elisabeth / Hewison, Cathy / Varaine, Francis

American journal of respiratory and critical care medicine

2015 Volume 192, Issue 1, Page(s) 117–118

MeSH term(s)	Antitubercular Agents/therapeutic use ; Female ; Humans ; Male ; Microbial Sensitivity Tests ; Mycobacterium tuberculosis/drug effects ; Tuberculosis, Multidrug-Resistant/drug therapy
Chemical Substances	Antitubercular Agents
Language	English
Publishing date	2015-07-01
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.201504-0747LE
Database	MEDical Literature Analysis and Retrieval System OnLINE

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