scholarly journals Predictive factors for unfavourable treatment in MDR-TB and XDR-TB patients in Rio de Janeiro State, Brazil, 2000-2016

2019 ◽  
Author(s):  
Marcela Bhering ◽  
Raquel Duarte ◽  
Afrânio Kritski
Keyword(s):  
Rio De Janeiro ◽  
Treatment Options ◽  
New Drugs ◽  
Hiv Positive ◽  
Unfavourable Outcome ◽  
Factors Associated ◽  
Mdr Tb ◽  
Logistic Regressions ◽  
Primary Transmission ◽  
Janeiro State

AbstractSettingThe State of Rio de Janeiro stands out as having the second highest incidence and the highest mortality rate due to TB in Brazil. This study aims at identifying the factors associated with the unfavourable treatment of MDR/XDR-TB patients in that State.MethodData on 2269 MDR-TB cases reported in 2000-2016 in Rio de Janeiro State were collected from the Tuberculosis Surveillance System. Bivariate and multivariate logistic regressions were run to estimate the factors associated with unfavourable outcomes (failure, default, and death) and, specifically, default and death.ResultsThe proportion of unfavourable outcomes was 41.9% among MDR-TB and 81.5% among XDR-TB. Having less than 8 years of schooling, and being an Afro-Brazilian, under 40 years old and drug user were associated with unfavourable outcome and default. Bilateral disease, HIV positive, and comorbidities were associated with death. XDR-TB cases had a 4.7-fold higher odds of an unfavourable outcome, with 29.3% of such cases being in the first treatment for multidrug resistance.ConclusionAbout 30% of XDR-TB cases may have occurred by primary transmission. The high rates of failure and death in this category reflect the limitation of treatment options. This highlights the urgency to incorporate new drugs in the treatment.

scholarly journals Treatment outcomes and predictive factors for multidrug-resistant TB and HIV coinfection in Rio de Janeiro State, Brazil

2021 ◽  
Vol 25 (4) ◽  
pp. 292-298
Author(s):  
M. Bhering ◽  
R. Duarte ◽  
A. Kritski
Keyword(s):  
Treatment Outcomes ◽  
Rio De Janeiro ◽  
Illicit Drugs ◽  
Multidrug Resistant ◽  
Hiv Positive ◽  
Factors Associated ◽  
Unsuccessful Treatment ◽  
Mdr Tb ◽  
Janeiro State ◽  
Hiv Negative

BACKGROUND: Brazil ranks 14th worldwide in the number of TB cases and 19th in terms of TB-HIV co-infected cases. This study aims at identifying clinical and demographic factors associated with unsuccessful treatment outcomes (loss to follow-up, treatment failure and death) of HIV-positive patients with multidrug-resistant TB (MDR-TB) in Rio de Janeiro State, Brazil.METHODS: This was a retrospective cohort study of MDR-TB cases notified from 2000 to 2016 in RJ. Cox proportional hazard regression models were used to assess risk factors associated with unsuccessful treatment in HIV-positive patients with MDR-TB.RESULTS: Among 2,269 patients, 156 (6.9%) were HIV-positive and had a higher proportion of unsuccessful treatment outcomes (52.6%) than HIV-negative cases (43.7%). All HIV-positive cases with extensively drug-resistant TB (XDR-TB) had unsuccessful treatment outcomes. Multivariate analysis shows that previous MDR-TB treatment (HR 1.97, 95% CI 1.22–3.18) and illicit drugs use (HR 1.68, 95% CI 1.01–2.78) were associated with a greater hazard of unsuccessful treatment outcomes, while 6-month culture conversion (HR 0.48, 95% CI 0.27–0.84) and use of antiretroviral therapy (ART) (HR 0.51, 95% CI 0.32–0.80) were predictors of reduced risk.CONCLUSIONS: Unsuccessful treatment was higher among HIV patients with MDR-TB than among HIV-negative patients. Prompt initiation of ART and effective interventions are necessary to improve treatment adherence and prevent retreatment cases.

scholarly journals Treatment Outcomes and Predictive Factors for Multidrug-Resistant TB and HIV Coinfection in Rio De Janeiro State, Brazil

2020 ◽  
Author(s):  
Marcela Lopes Bhering ◽  
Raquel Duarte ◽  
Afrânio Kritski
Keyword(s):  
Treatment Outcomes ◽  
Rio De Janeiro ◽  
Protective Factor ◽  
Multidrug Resistant ◽  
Hiv Positive ◽  
Loss To Follow Up ◽  
Factors Associated ◽  
Hiv Coinfection ◽  
Mdr Tb

Abstract Background: This study aims to identify and compare factors associated with the unfavorable treatment of MDR-TB patients with HIV coinfection in the State of Rio de Janeiro (RJ), Brazil.Methods: A retrospective cohort study with data from TB-MDR patients notified between 2000 and 2016 in RJ. Clinical and epidemiological characteristics and treatment outcomes of patients with HIV positive, negative, and unknown were compared. Bivariate and multivariate Cox hazard regression analysis was conducted to identify factors associated with unfavorable treatment results in patients MDR-TB / HIV positive. Results: Of 2,269 cases, 1,999 (88.1%) had a negative result for HIV, 156 (6.9%) positive and 114 (5.0%) unknown. The proportion of unfavourable outcomes was 43.7% among HIV negative, 52.6% among HIV positive and 43.9% among HIV unknown. Regarding MDR-TB / HIV positive cases, the unfavorable outcomes more prevalent were loss to follow up (24.4%) and death (23.1%). Previous MDR-TB treatment was associated with unsuccess and death. Illicit drugs use was a risk factor for unsuccess and loss to follow up. The six-month culture conversion was a protective factor for unsuccess and death. Administration of antiretroviral therapy was a protective factor for unsuccess, death and failure. The risk of XDR-TB cases for failure was six times higher than that of MDR-TB patients. All XDR-TB / HIV positive cases had unfavorable outcomes.Conclusions: Early identification and immediate initiation of appropriate treatment are key to reducing unfavorable outcomes among MDR-TB / HIV positive. The high proportions of loss to follow-up and death may reflect difficulties in monitoring treatment, due to poor integration between the TB and HIV programs. In addition, none of XDR-TB / HIV positive patient had therapeutic success, highlighting the urgency to incorporate new drugs for the treatment of multidrug-resistant TB by Brazil's Ministry of Health.

scholarly journals Acceptability of Voluntary Counselling and Testing (VCT) Among Tuberculosis (TB) Patients in Ghana

2021 ◽  
Vol 9 (2) ◽  
pp. 118-128
Author(s):  
Ibrahim Ibn Saana
Keyword(s):  
Treatment Options ◽  
Rapid Test ◽  
Test Methods ◽  
Hiv Positive ◽  
Demographic Information ◽  
Tuberculosis Patients ◽  
Factors Associated ◽  
Logistic Regression Method ◽  
Rapid Test Methods ◽  
Voluntary Counselling And Testing

Patients should first be counselled and tested for HIV to benefit from available care and treatment options. The aim of this paper was to find out the level of acceptance of HIV testing among patients who visit the Chest Diseases Clinic of the Korle-Bu Teaching Hospital, Ghana. Information about all adult tuberculosis patients who attended the clinic between January and December 2019 in which patients’ socio-demographic information and tuberculosis treatment history were taken from the TB register, patients who showed initial willingness were referred to a VCT counsellor for HIV counselling before testing was done. Rapid test methods were used, and the results were disclosed. The logistic regression method was used to assess the factors associated with HIV co-infection, willingness, and acceptability. 250 tuberculosis (TB) patients who were among the total of 485 gave their consent and willingly participated in this study. Their median age was 30 years (range, 13–50+), and 56.8% of them were females. 29 patients had tested previously, including 29 HIV positive. 66.0% (165) were willing to be tested.

scholarly journals Predictive factors for unfavourable treatment in MDR-TB and XDR-TB patients in Rio de Janeiro State, Brazil, 2000-2016

PLoS ONE ◽  
2019 ◽  
Vol 14 (11) ◽  
pp. e0218299 ◽  
Author(s):  
Marcela Bhering ◽  
Raquel Duarte ◽  
Afrânio Kritski
Keyword(s):  
Predictive Factors ◽  
Rio De Janeiro ◽  
Mdr Tb ◽  
Janeiro State

scholarly journals Tuberculosis among individuals with community-acquired pneumonia presenting to emergency in Gaborone, Botswana

2018 ◽  
Author(s):  
Jill K. Gersh ◽  
Zachary Feldman ◽  
Emily Greenberger ◽  
Amit Chandra ◽  
Harvey M. Friedman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Community Acquired Pneumonia ◽  
Clinical Syndrome ◽  
Hiv Positive ◽  
Sputum Smear ◽  
Clinical Factors ◽  
Pulmonary Tb ◽  
Factors Associated ◽  
Logistic Regressions

Delays in diagnosing Tuberculosis (TB) are associated with increased transmission. TB may present as a clinical syndrome that mimics community-acquired pneumonia (CAP). The aim of this paper was to determine frequency of TB among patients with CAP at a referral hospital in Gaborone, Botswana. We performed a retrospective study of adults presenting with CAP from April 2010-October 2011 to the Emergency Department (ED); we matched this cohort to the National Botswana Tuberculosis Registry (NBTR) to identify individuals subsequently diagnosed with TB. We assessed demographics, time to TB diagnosis, clinical outcomes and performed logistic regressions to identify factors associated with TB diagnosis. We identified 1305 individuals presenting with CAP; TB was subsequently diagnosed in 68 (5.2%). The median time to TB diagnosis was 9.5 days. Forty percent were AFB sputum smear positive and 87% were identified as being HIV-positive. Subsequent diagnosis of TB is common among individuals with CAP at our ED, suggesting that TB may be present at the time of CAP presentation. Given the lack of distinguishing clinical factors between pulmonary TB and CAP, adults presenting with CAP should be evaluated for active TB in Botswana.

scholarly journals Factors associated with unfavourable treatment outcomes among people with rifampicin-resistant tuberculosis in Armenia, 2014-2017

2021 ◽  
Vol 91 (1) ◽  
Author(s):  
Lilit Khachatryan ◽  
Ruzanna Grigoryan ◽  
Andrei Dadu ◽  
Ajay M.V. Kumar ◽  
Kristina Akopyan ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Treatment Outcomes ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
New Drugs ◽  
Health Concern ◽  
Factors Associated ◽  
Resistant Tuberculosis ◽  
Home Based ◽  
Mdr Tb

Rifampicin-Resistant/Multidrug-Resistant Tuberculosis (RR/MDR-TB) is recognized as a major public health concern globally. In Armenia, the proportion of RR/MDR-TB is increasing among all people affected with TB. We conducted a nationwide cohort study involving analysis of programmatic data to investigate the rates of and factors associated with unfavourable treatment outcomes among patients with RR/MDR-TB registered by the national TB programme from 2014 to 2017 in Armenia. We used Cox regression to identify factors associated with the outcome. Among 451 RR/MDR-TB patients, 80% were men and median age was 46 years. Of them, 53 (11.8%) had Extensively Drug-Resistant Tuberculosis (XDR-TB) and 132 (29.3%) had pre-XDR-TB. Almost half (224, 49.7%) of the patients had unfavourable treatment outcome, which included 26.8% Loss To Follow-Up (LTFU), 13.3% failures and 9.5% deaths. In multivariable analysis, people with pre-XDR-TB [adjusted Hazard Ratio [aHR] 3.13, 95% confidence intervals [CI] 2.16-4.55] and XDR-TB (aHR 4.08, 95% CI 2.45-6.79) had a higher risk of unfavourable outcomes. Patients receiving home-based treatment (71/451, 15.7%) and treatment with new drugs (172/451, 38.1%) had significantly lower risk (aHR 0.45, 95% CI 0.28-0.72 and aHR 0.26, 95% CI 0.18-0.39) of unfavourable treatment outcome.  The proportion of MDR-TB patients reaching favourable treatment outcome in Armenia was substantially lower than the recommended level (75%). The most common treatment outcome was LTFU indicating the need for further assessment of underlying determinants. Home-based treatment looks promising and future studies are required to see if expanding it to all RR/MDR-TB patients is feasible and cost-effective.

scholarly journals Triple class experience after initiation of combination antiretroviral treatment in Australia: survival and projections

Sexual Health ◽  
2011 ◽  
Vol 8 (3) ◽  
pp. 295 ◽  
Author(s):  
Sadaf Marashi Pour ◽  
Ian Woolley ◽  
Peter Canavan ◽  
John Chuah ◽  
Darren B. Russell ◽  
...  
Keyword(s):  
Antiretroviral Treatment ◽  
Proportional Hazards ◽  
Treatment Options ◽  
Cox Proportional Hazards ◽  
New Drugs ◽  
Factors Associated ◽  
Current Trends ◽  
Cox Proportional Hazards Models ◽  
Number Of Patients ◽  
Significant Difference

Background Patients who have become triple class experienced (TCE) are at a high risk of exhausting available treatment options. This study aims to investigate factors associated with becoming TCE and to explore the effect of becoming TCE on survival. We also project the prevalence of TCE in Australia to 2012. Methods: Patients were defined as TCE when they stopped a combination antiretroviral treatment (cART) that introduced the third of the three major antiretroviral classes. Cox proportional hazards models were used to investigate factors associated with TCE and the effect of TCE on survival. To project TCE prevalence, we used predicted rates of TCE by fitting a Poisson regression model, together with the estimated number of patients who started cART in each year in Australia, assuming a mortality rate of 1.5 per 100 person-years. Results: Of the 1498 eligible patients, 526 became TCE. Independent predictors of a higher risk of TCE included current CD4 counts below 200 cells μL–1 and earlier calendar periods. No significant difference in survival was observed between those who were TCE and those who were not yet TCE. An increasing number of patients are using cART in Australia and if current trends continue, the number of patients who are TCE is estimated to increase from 2800 in 2003 to 5000 in 2012. Conclusion: Our results suggest that the prevalence of TCE in Australia is estimated to plateau after 2003. However, as an increasing number of patients are becoming TCE, it is necessary to develop new drugs that come from new classes or do not have overlapping resistance.

scholarly journals Primary and acquired multidrug-resistant tuberculosis: Predictive factors for unfavorable treatment outcomes in Rio de Janeiro, 2000–2016

2020 ◽  
Vol 44 ◽  
pp. 1
Author(s):  
Marcela Bhering ◽  
Afrânio Kritski
Keyword(s):  
Rio De Janeiro ◽  
Acquired Resistance ◽  
Multidrug Resistant ◽  
Primary Resistance ◽  
Loss To Follow Up ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Janeiro State

Objective. To identify clinical and demographic factors associated with unfavorable treatment outcomes in patients with primary and acquired multidrug-resistant tuberculosis (MDR-TB) in Rio de Janeiro State. Methods. Retrospective cohort study using data on 2 269 MDR-TB cases in 2000–2016. Factors associated with unsuccessful, loss to follow-up, and death outcomes in patients with primary and acquired resistance were investigated with bivariate and multivariate regression. Results. Primary resistance was 14.7% among MDR-TB cases. The unfavorable outcomes proportion was 30.3% in the primary resistance group and 46.7% in the acquired resistance group. There were significant differences in demographic and clinical characteristics between the two groups. Proportionally, the group with primary resistance had more cases among women (46.4% vs. 33.5% in the acquired resistance group), Caucasians (47.3% and 34%), and those with ≥8 years of schooling (37.7% and 27.4%). Extensively drug-resistant TB patients had 12.2-fold higher odds of unsuccessful outcome than MDR-TB patients, and comorbidities had 2-fold higher odds in the primary resistance group. Extensively drug-resistant TB had 5.43-fold higher odds in the acquired MDR-TB group. Bilateral disease and <8 years of schooling were associated with unsuccessful outcome in both groups. Being an inmate had 8-fold higher odds of loss to follow-up in the primary resistance group. Culture conversion by the sixth month was a protective factor for all outcomes. Conclusions. Primary resistance cases of MDR-TB constitute a different transmission reservoir, which is related to other chronic diseases associated with higher acquisition of TB. The poor results observed in Rio de Janeiro State can contribute to increasing the transmission of primary MDR-TB, thus favoring drug resistance.

Antiretroviral Treatment-Associated Labia Majora Lipohypertrophy: A Rare Case and Plastic Surgical Treatment Options

2017 ◽  
Vol 2 (1) ◽  
pp. 43
Author(s):  
Akmal Hisham ◽  
Devananthan Ilenghoven ◽  
Wan Syazli Wan Ahmad Kamal ◽  
Salina Ibrahim ◽  
Shah Jumaat Mohd Yussof
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Daily Living ◽  
Treatment Options ◽  
Hiv Positive ◽  
Highly Active ◽  
Labia Majora ◽  
The Face ◽  
Central Fat

The emergence of highly active antiretroviral therapy (HAART) has revolutionized the prognosis of HIV-infected patients. However, the extended use of HAART is associated with a disfiguring complication termed lipodystrophy, a disorder of body fat maldistribution causing peripheral fat loss (lipoatrophy) and central fat accumulation (lipohypertrophy). Lipoatrophy commonly affects the face, legs, buttocks and arm, whilst lipohypertrophy frequently favours the abdomen, breast and dorsocervical region. To our knowledge, we present only the second documented case in the literature of a labia majora lipohypertrophy in a HIV-positive patient receiving long-term HAART. The severity of labial abnormality caused significant physical and functional morbidities. Labiaplasty with dermolipectomy of the labia majora and excisional lipectomy of the mons pubis was successfully performed. At a 6-month follow-up, patient had no recurrence with resolution of symptoms and resumption of normal activities of daily living (ADL).

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