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

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 no...

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Autores principales: Jones-López, Edward C., Ayakaka, Irene, Levin, Jonathan, Reilly, Nancy, Mumbowa, Francis, Dryden-Peterson, Scott, Nyakoojo, Grace, Fennelly, Kevin, Temple, Beth, Nakubulwa, Susan, Joloba, Moses L., Okwera, Alphonse, Eisenach, Kathleen D., McNerney, Ruth, Elliott, Alison M., Ellner, Jerrold J., Smith, Peter G., Mugerwa, Roy D.
Formato: Texto
Lenguaje:English
Publicado: Public Library of Science 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058098/
https://www.ncbi.nlm.nih.gov/pubmed/21423586
http://dx.doi.org/10.1371/journal.pmed.1000427
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author Jones-López, Edward C.
Ayakaka, Irene
Levin, Jonathan
Reilly, Nancy
Mumbowa, Francis
Dryden-Peterson, Scott
Nyakoojo, Grace
Fennelly, Kevin
Temple, Beth
Nakubulwa, Susan
Joloba, Moses L.
Okwera, Alphonse
Eisenach, Kathleen D.
McNerney, Ruth
Elliott, Alison M.
Ellner, Jerrold J.
Smith, Peter G.
Mugerwa, Roy D.
author_facet Jones-López, Edward C.
Ayakaka, Irene
Levin, Jonathan
Reilly, Nancy
Mumbowa, Francis
Dryden-Peterson, Scott
Nyakoojo, Grace
Fennelly, Kevin
Temple, Beth
Nakubulwa, Susan
Joloba, Moses L.
Okwera, Alphonse
Eisenach, Kathleen D.
McNerney, Ruth
Elliott, Alison M.
Ellner, Jerrold J.
Smith, Peter G.
Mugerwa, Roy D.
author_sort Jones-López, Edward C.
collection PubMed
description 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
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spelling pubmed-30580982011-03-21 Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study Jones-López, Edward C. Ayakaka, Irene Levin, Jonathan Reilly, Nancy Mumbowa, Francis Dryden-Peterson, Scott Nyakoojo, Grace Fennelly, Kevin Temple, Beth Nakubulwa, Susan Joloba, Moses L. Okwera, Alphonse Eisenach, Kathleen D. McNerney, Ruth Elliott, Alison M. Ellner, Jerrold J. Smith, Peter G. Mugerwa, Roy D. PLoS Med Research Article 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 Public Library of Science 2011-03-15 /pmc/articles/PMC3058098/ /pubmed/21423586 http://dx.doi.org/10.1371/journal.pmed.1000427 Text en Jones-López et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Jones-López, Edward C.
Ayakaka, Irene
Levin, Jonathan
Reilly, Nancy
Mumbowa, Francis
Dryden-Peterson, Scott
Nyakoojo, Grace
Fennelly, Kevin
Temple, Beth
Nakubulwa, Susan
Joloba, Moses L.
Okwera, Alphonse
Eisenach, Kathleen D.
McNerney, Ruth
Elliott, Alison M.
Ellner, Jerrold J.
Smith, Peter G.
Mugerwa, Roy D.
Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study
title Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study
title_full Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study
title_fullStr Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study
title_full_unstemmed Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study
title_short Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study
title_sort effectiveness of the standard who recommended retreatment regimen (category ii) for tuberculosis in kampala, uganda: a prospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058098/
https://www.ncbi.nlm.nih.gov/pubmed/21423586
http://dx.doi.org/10.1371/journal.pmed.1000427
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