Poor outcomes in recurrent tuberculosis: More than just drug resistance?

• Published in: PloS one Vol. 14; no. 5; p. e0215855
• Main Authors: Cohen, Danielle B, Davies, Geriant, Malwafu, Wakisa, Mangochi, Helen, Joekes, Elizabeth, Greenwood, Simon, Corbett, Liz, Squire, S Bertel
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.05.2019; Public Library of Science (PLoS)
• Subjects: Adult; Analysis; Anemia; Antimicrobial agents; Antiretroviral agents; Antiretroviral therapy; Antitubercular agents; Biology and Life Sciences; Bronchiectasis; Care and treatment; Chronic Disease; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Clinical outcomes; Cohort Studies; Comorbidity; Diabetes; Diabetes mellitus; Drug resistance; Drug Resistance, Bacterial; Drug toxicity; Failure; Female; Follow-Up Studies; HIV; HIV - physiology; Hospitals; Human immunodeficiency virus; Humans; Impairment; Laboratories; Liver; Lung diseases; Lung Diseases - complications; Male; Medical research; Medical schools; Medicine; Medicine and Health Sciences; Microbial drug resistance; Morbidity; Mortality; Ototoxicity; Patients; Peripheral neuropathy; Prognosis; Recurrence; Recurrence (Disease); Renal function; Research and Analysis Methods; Respiratory tract diseases; Scars; Spirometry; Systematic review; Thorax; Toxicity; Treatment outcome; Tuberculosis; Tuberculosis - complications; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis - virology; United Kingdom > UK; Malawi; Europe
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0215855

Approximately 11% of people reported to have tuberculosis (TB) have previously received treatment. Clinical outcomes are consistently poor on retreatment regimens, however reasons for this are unclear. This study aimed to explore factors which may contribute to unsuccessful outcomes in retreatment TB. A prospective cohort of consecutive patients starting WHO Category II retreatment regimen was recruited at a central hospital in Malawi. Participants were evaluated at baseline, after completion of the intensive phase at 2-months, and at the end of the 8-month treatment course. Patients were assessed for respiratory co-morbidity; anaemia; renal impairment; diabetes; Anti-retroviral (ART) failure; and drug toxicity. Amongst 158 patients entering TB care at the point of a recurrent episode, only 92 (58%) had a microbiologically confirmed diagnosis. The prevalence of drug resistance was low (9.6%). Of the 158 patients, 131 (83%) were HIV-positive, of whom 96 (73%) were on ART. Of 63 patients on ART >1 year, 24 (38%) had ART failure. Chronic lung disease was found in 88% on CT thorax, including scarring (80%), bronchiectasis (61%), COPD (22%), and destroyed lung (19%). Spirometry revealed restrictive deficit in 60%, and obstructive deficit in 7% of patients. Anaemia and renal impairment were common (34% and 45% respectively). Ototoxicity developed in 32%, and nephrotoxicity in 15%. 40% of patients reported peripheral neuropathy. Liver injury developed in 4%. If outcomes are to be improved in retreatment TB, there is an urgent need to address the impact of other co-morbid medical conditions including chronic lung disease, HIV and ART failure.