Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study

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Background:
Each year, 10%–20% of patients with tuberculosis (TB) in low- and middle-income countries present with previously treated TB and are empirically started on a World Health Organization (WHO)-recommended standardized retreatment regimen. The effectiveness of this retreatment regimen has not been systematically evaluated.

Methods and Findings:
From July 2003 to January 2007, we enrolled smear-positive, pulmonary TB patients into a prospective cohort to study treatment outcomes and mortality during and after treatment with the standardized retreatment regimen. Median time of follow-up was 21 months (interquartile range 12–33 months). A total of 29/148 (20%) HIV-uninfected and 37/140 (26%) HIV-infected patients had an unsuccessful treatment outcome. In a multiple logistic regression analysis to adjust for confounding, factors associated with an unsuccessful treatment outcome were poor adherence (adjusted odds ratio [aOR] associated with missing half or more of scheduled doses 2.39; 95% confidence interval (CI) 1.10–5.22), HIV infection (2.16; 1.01–4.61), age (aOR for 10-year increase 1.59; 1.13–2.25), and duration of TB symptoms (aOR for 1-month increase 1.12; 1.04–1.20). All patients with multidrug-resistant TB had an unsuccessful treatment outcome. HIV-infected individuals were more likely to die than HIV-uninfected individuals (p<0.0001). Multidrug-resistant TB at enrolment was the only common risk factor for death during follow-up for both HIV-infected (adjusted hazard ratio [aHR] 17.9; 6.0–53.4) and HIV-uninfected (14.7; 4.1–52.2) individuals. Other risk factors for death during follow-up among HIV-infected patients were CD4<50 cells/ml and no antiretroviral treatment (aHR 7.4, compared to patients with CD4≥200; 3.0–18.8) and Karnofsky score <70 (2.1; 1.1–4.1); and among HIV-uninfected patients were poor adherence (missing half or more of doses) (3.5; 1.1–10.6) and duration of TB symptoms (aHR for a 1-month increase 1.9; 1.0–3.5).

Conclusions:
The recommended regimen for retreatment TB in Uganda yields an unacceptable proportion of unsuccessful outcomes. There is a need to evaluate new treatment strategies in these patients.

: Please see later in the article for the Editors' Summary

Vyšlo v časopise: Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study. PLoS Med 8(3): e32767. doi:10.1371/journal.pmed.1000427
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1000427

Souhrn

Zdroje

1. MakA

ThomasA

Del GranadoM

ZaleskisR

MouzafarovaN

2008 Influence of multidrug resistance on tuberculosis treatment outcomes with standardized regimens. Am J Respir Crit Care Med 178 306 312

2. World Health Organization 2009 Global tuberculosis control - a short update to the 2009 report Geneva World Health Organization

3. MenziesD

BenedettiA

PaydarA

RoyceS

PaiM

2009 Standardized treatment of active tuberculosis in patients with previous treatment and/or with mono-resistance to isoniazid: a systematic review and meta-analysis. PLoS Med 6 e1000150 doi:10.1371/journal.pmed.1000150

4. RouillonA

1991 The Mutual Assistance Programme of the IUATLD. Development, contribution and significance. Bull Int Union Tuberc Lung Dis 66 159 172

5. World Health Organization 2009 Treatment of tuberculosis: guidelines – 4th edition Geneva World Health Organization

6. World Health Organization 2006 Guidelines for the programmatic management of drug-resistant tuberculosis Geneva World Health Organization

7. EspinalMA

2003 Time to abandon the standard retreatment regimen with first-line drugs for failures of standard treatment. Int J Tuberc Lung Dis 7 607 608

8. MatthysF

RigoutsL

SizaireV

VezhninaN

LecoqM

2009 Outcomes after chemotherapy with WHO category II regimen in a population with high prevalence of drug resistant tuberculosis. PLoS One 4 e7954 doi:10.1371/journal.pone.0007954

9. QuyHT

LanNT

BorgdorffMW

GrossetJ

LinhPD

2003 Drug resistance among failure and relapse cases of tuberculosis: is the standard re-treatment regimen adequate? Int J Tuberc Lung Dis 7 631 636

10. CavalcanteSC

SoaresEC

PachecoAG

ChaissonRE

DurovniB

2007 Community DOT for tuberculosis in a Brazilian favela: comparison with a clinic model. Int J Tuberc Lung Dis 11 544 549

11. ChurchyardGJ

CorbettEL

KleinschmidtI

MulderD

De CockKM

2000 Drug-resistant tuberculosis in South African gold miners: incidence and associated factors. Int J Tuberc Lung Dis 4 433 440

12. EspinalMA

KimSJ

SuarezPG

KamKM

KhomenkoAG

2000 Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcomes in 6 countries. JAMA 283 2537 2545

13. KimerlingME

KlugeH

VezhninaN

IacovazziT

DemeulenaereT

1999 Inadequacy of the current WHO re-treatment regimen in a central Siberian prison: treatment failure and MDR-TB. Int J Tuberc Lung Dis 3 451 453

14. KirondeS

MeintjiesM

2002 Tuberculosis treatment delivery in high burden settings: does patient choice of supervision matter? Int J Tuberc Lung Dis 6 599 608

15. OttmaniSE

ZignolM

BencheikhN

LaasriL

ChaoukiN

2006 Results of cohort analysis by category of tuberculosis retreatment cases in Morocco from 1996 to 2003. Int J Tuberc Lung Dis 10 1367 1372

16. PardeshiGS

DeshmukhD

2007 A comparison of treatment outcome in re-treatment versus new smear positive cases of tuberculosis under RNTCP. Indian J Public Health 51 237 239

17. SalaniponiFM

NyirendaTE

KempJR

SquireSB

Godfrey-FaussettP

2003 Characteristics, management and outcome of patients with recurrent tuberculosis under routine programme conditions in Malawi. Int J Tuberc Lung Dis 7 948 952

18. SanthaT

GargR

FriedenTR

ChandrasekaranV

SubramaniR

2002 Risk factors associated with default, failure and death among tuberculosis patients treated in a DOTS programme in Tiruvallur District, South India, 2000. Int J Tuberc Lung Dis 6 780 788

19. SaraviaJC

AppletonSC

RichML

SarriaM

BayonaJ

2005 Retreatment management strategies when first-line tuberculosis therapy fails. Int J Tuberc Lung Dis 9 421 429

20. SchreiberYS

HerreraAF

WilsonD

WallengrenK

DraperR

2009 Tuberculosis retreatment category predicts resistance in hospitalized retreatment patients in a high HIV prevalence area. Int J Tuberc Lung Dis 13 1274 1280

21. SevimT

AtacG

GungorG

TorunI

AksoyE

2002 Treatment outcome of relapse and defaulter pulmonary tuberculosis patients. Int J Tuberc Lung Dis 6 320 325

22. ToungoussovaOS

NizovtsevaNI

MariandyshevAO

CaugantDA

SandvenP

2004 Impact of drug-resistant Mycobacterium tuberculosis on treatment outcome of culture-positive cases of tuberculosis in the Archangel oblast, Russia, in 1999. Eur J Clin Microbiol Infect Dis 23 174 179

23. CoxH

KebedeY

AllamuratovaS

IsmailovG

DavletmuratovaZ

2006 Tuberculosis recurrence and mortality after successful treatment: impact of drug resistance. PLoS Med 3 e384 doi:10.1371/journal.pmed.0030384

24. WellsCD

CegielskiJP

NelsonLJ

LasersonKF

HoltzTH

2007 HIV infection and multidrug-resistant tuberculosis: the perfect storm. J Infect Dis 196 Suppl 1 S86 S107

25. Ministry of Health 2003 Uganda national antiretroviral treatment and care guidelines for adults and children. 1st edition Kampala, Uganda Ministry of Health

26. 2000 diagnostic standards and classification of tuberculosis in adults and children. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999. Am J Respir Crit Care Med 161 1376 1395

27. 1996 Bactec 460 system: product and procedure manual Sparks (Maryland) Becton, Dickenson, and Company

28. 1999 Bactec MGIT 960 system user's manual Sparks (Maryland) Becton, Dickenson, and Company

29. MuhumuzaJ

AsiimweBB

KayesS

MugyenyiR

WhalenC

2006 Introduction of an in-house PCR for routine identification of M. tuberculosis in a low-income country. Int J Tuberc Lung Dis 10 1262 1267

30. World Health Organization 2004 Rapid HIV tests: guidelines for use in HIV testing and counselling services in resource-constrained settings Geneva World Health Organization

31. GreenlandS

2008 Chapter 21: introduction to regression modeling.

RothmanKJ

GreenlandS

LashTL

Modern epidemiology. 3rd edition Baltimore Lippincott, Williams, and Wilkins

32. RoystonP

AmblerG

SauerbreiW

1999 The use of fractional polynomials to model continuous risk variables in epidemiology. Int J Epidemiol 28 964 974

33. GrambschPM

TherneauTM

1994 Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81 515 526

34. Abdool KarimSS

NaidooK

GroblerA

PadayatchiN

BaxterC

2010 Timing of initiation of antiretroviral drugs during tuberculosis therapy. N Engl J Med 362 697 706

35. LasersonKF

ThorpeLE

LeimaneV

WeyerK

MitnickCD

2005 Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 9 640 645

36. TempleB

AyakakaI

OgwangS

NabanjjaH

KayesS

2008 Rate and amplification of drug resistance among previously-treated patients with tuberculosis in Kampala, Uganda. Clin Infect Dis 47 1126 1134

37. GandhiNR

MollA

SturmAW

PawinskiR

GovenderT

2006 Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet 368 1575 1580

38. GandhiNR

ShahNS

AndrewsJR

VellaV

MollAP

2010 HIV coinfection in multidrug- and extensively drug-resistant tuberculosis results in high early mortality. Am J Respir Crit Care Med 181 80 86

39. PellyT

MooreDA

GilmanR

EvansC

2004 Recent tuberculosis advances in Latin America. Curr Opin Infect Dis 17 397 403

40. KeshavjeeS