THAB0102 - Oral Abstract
Impact of HIV on early MDR-TB treatment outcomes in Botswana
Presented by Jeffrey Hafkin (United States).
J. Hafkin1, C. Modongo2, C. Newcomb1, E. Lowenthal3, R.R. MacGregor1, A. Steenhoff2,3, H. Friedman1, G. Bisson1
1University of Pennsylvania, Philadelphia, United States, 2Botswana UPenn Partnership, Gaborone, Botswana, 3Children's Hospital of Philadelphia, Philadelphia, United States
Background: The impact of HIV on MDR-TB treatment outcomes in sub-Saharan Africa remains unclear where extensive rollout of highly active antiretroviral
therapy (HAART) has occurred. We therefore compared the time
to initial culture conversion among patients with and without HIV infection in
a setting of individualized, ambulatory MDR-TB care in Botswana.
Methods: We performed a prospective
cohort study of MDR-TB patients receiving ambulatory care at two public clinics
in Botswana. The time to culture conversion and proportion converting were
compared by HIV status using Cox proportional hazard ratios (HRs).
HIV-infected and 30 HIV-uninfected patients with MDR-TB and follow up cultures
were identified. The median CD4+T-lymphocyte count of those with HIV was 215
cells/mm3 (IQR 129-347), and 36 (90%) were on HAART. 85% of
HIV-infected and 83% of HIV-uninfected achieved culture clearance. The median
time to initial culture conversion was 78 days (IQR 42-186) for HIV-infected
and 95 days (IQR 70-133)for HIV-uninfected individuals [log rank p = 0.62; unadjusted
HR=0.9 (95% CI: 0.5 to 1.5)]. Adjusting for age, gender, TB treatment history
and number of active antitubercular drugs used did not change this result
[adjusted HR=0.8 (95% CI: 0.4 to 1.4)]. Toxicity was frequent in all subjects:
ototoxicity occurred in 53% and 70%, neuropathy in 40% and 10%, and nephropathy
in 25% and 7% of HIV-infected and uninfected patients, respectively. Neuropathy
(p=0.005) & nephropathy (p=0.044) were significantly associated with HIV
found no difference in the proportion or time to initial sputum culture
conversion between an HIV-infected and non-infected cohort of MDR-TB patients
in Botswana. These results suggest that microbiologic outcomes among those with
HIV can be comparable to those without HIV in similar settings with access to
individualized TB treatment and HAART.
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