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Poor outcomes in a cohort of HIV-infected adolescents undergoing treatment for multidrug-resistant tuberculosis in Mumbai, India.

Isaakidis P, Paryani R, Khan S, Mansoor H, Manglani M, Valiyakath A, Saranchuk P, Furin J - PLoS ONE (2013)

Bottom Line: Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results.Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral.Operational research among co-infected adolescents will be especially important in designing effective interventions for this vulnerable group.

View Article: PubMed Central - PubMed

Affiliation: Médecins Sans Frontières, Mumbai, India. msfocb-asia-epidemio@brussels.msf.org

ABSTRACT

Background: Little is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10-19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF) project in Mumbai, India.

Methods: A retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation.

Results: The median age was 16 (IQR 14-18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8-250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens.

Conclusions: Early mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial support for co-infected adolescents. Operational research among co-infected adolescents will be especially important in designing effective interventions for this vulnerable group.

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Related in: MedlinePlus

Flowchart of the Mumbai HIV/MDR-TB co-infected adolescent cohort, 2007–2013.
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pone-0068869-g001: Flowchart of the Mumbai HIV/MDR-TB co-infected adolescent cohort, 2007–2013.

Mentions: The median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8–250.5). Five patients were on ART at the time of the MDR-TB diagnosis: two of them were on ART for more than 2 years and three of them for six months or less. Another three patients were started on ART following initiation of DR-TB treatment: two patients after seven months and one patient after one month of TB treatment (Table 2). The median time from diagnosis of MDR-TB to initiation of second-line treatment was 10 days (IQR: 7–12). Three patients did not start antiretroviral and second-line TB treatments as they died soon after enrolment (Figure 1). Routine HIV viral load monitoring was not available during the early years of the program.


Poor outcomes in a cohort of HIV-infected adolescents undergoing treatment for multidrug-resistant tuberculosis in Mumbai, India.

Isaakidis P, Paryani R, Khan S, Mansoor H, Manglani M, Valiyakath A, Saranchuk P, Furin J - PLoS ONE (2013)

Flowchart of the Mumbai HIV/MDR-TB co-infected adolescent cohort, 2007–2013.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3716893&req=5

pone-0068869-g001: Flowchart of the Mumbai HIV/MDR-TB co-infected adolescent cohort, 2007–2013.
Mentions: The median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8–250.5). Five patients were on ART at the time of the MDR-TB diagnosis: two of them were on ART for more than 2 years and three of them for six months or less. Another three patients were started on ART following initiation of DR-TB treatment: two patients after seven months and one patient after one month of TB treatment (Table 2). The median time from diagnosis of MDR-TB to initiation of second-line treatment was 10 days (IQR: 7–12). Three patients did not start antiretroviral and second-line TB treatments as they died soon after enrolment (Figure 1). Routine HIV viral load monitoring was not available during the early years of the program.

Bottom Line: Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results.Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral.Operational research among co-infected adolescents will be especially important in designing effective interventions for this vulnerable group.

View Article: PubMed Central - PubMed

Affiliation: Médecins Sans Frontières, Mumbai, India. msfocb-asia-epidemio@brussels.msf.org

ABSTRACT

Background: Little is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10-19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF) project in Mumbai, India.

Methods: A retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation.

Results: The median age was 16 (IQR 14-18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8-250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens.

Conclusions: Early mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial support for co-infected adolescents. Operational research among co-infected adolescents will be especially important in designing effective interventions for this vulnerable group.

Show MeSH
Related in: MedlinePlus