Poor Outcomes in a Cohort of HIV-Infected Adolescents Undergoing Treatment for Multidrug-Resistant Tuberculosis in Mumbai, India

  • P. I
  • R. P
  • S. K
 et al. 
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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 Medecins Sans Frontieres (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/mul (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. © 2013 Isaakidis et al.

Author-supplied keywords

  • *Human immunodeficiency virus infection/dt [Drug T
  • *multidrug resistant tuberculosis/dt [Drug Therapy
  • *prognosis
  • *tuberculostatic agent/ae [Adverse Drug Reaction]
  • *tuberculostatic agent/cb [Drug Combination]
  • *tuberculostatic agent/dt [Drug Therapy]
  • CD4 lymphocyte count
  • Human immunodeficiency virus infection/dt [Drug Th
  • India
  • RNA directed DNA polymerase inhibitor/cb [Drug Com
  • RNA directed DNA polymerase inhibitor/dt [Drug The
  • abacavir plus lamivudine plus lopinavir plus riton
  • adolescent
  • adult
  • aminosalicylic acid/ae [Adverse Drug Reaction]
  • aminosalicylic acid/cb [Drug Combination]
  • aminosalicylic acid/dt [Drug Therapy]
  • amoxicillin plus clavulanic acid/ae [Adverse Drug
  • amoxicillin plus clavulanic acid/cb [Drug Combinat
  • amoxicillin plus clavulanic acid/dt [Drug Therapy]
  • antiretrovirus agent/ae [Adverse Drug Reaction]
  • antiretrovirus agent/cb [Drug Combination]
  • antiretrovirus agent/dt [Drug Therapy]
  • anxiety disorder/si [Side Effect]
  • article
  • atazanavir plus lamivudine plus ritonavir plus ten
  • bacterium culture
  • capreomycin/ae [Adverse Drug Reaction]
  • capreomycin/cb [Drug Combination]
  • capreomycin/dt [Drug Therapy]
  • child
  • clinical article
  • clofazimine/ae [Adverse Drug Reaction]
  • clofazimine/cb [Drug Combination]
  • clofazimine/dt [Drug Therapy]
  • cohort analysis
  • convulsion/si [Side Effect]
  • cycloserine/ae [Adverse Drug Reaction]
  • cycloserine/cb [Drug Combination]
  • cycloserine/dt [Drug Therapy]
  • drug megadose
  • drug withdrawal
  • efavirenz plus lamivudine plus stavudine/ae [Adver
  • efavirenz plus lamivudine plus stavudine/dt [Drug
  • efavirenz plus lamivudine plus tenofovir/ae [Adver
  • efavirenz plus lamivudine plus tenofovir/dt [Drug
  • ethambutol/ae [Adverse Drug Reaction]
  • ethambutol/cb [Drug Combination]
  • ethambutol/dt [Drug Therapy]
  • ethionamide/ae [Adverse Drug Reaction]
  • ethionamide/cb [Drug Combination]
  • ethionamide/dt [Drug Therapy]
  • extrapulmonary tuberculosis/dt [Drug Therapy]
  • female
  • gastrointestinal intolerance/si [Side Effect]
  • gastrointestinal symptom/si [Side Effect]
  • hearing impairment/si [Side Effect]
  • human
  • hypokalemia/si [Side Effect]
  • hypothyroidism/si [Side Effect]
  • isoniazid/ae [Adverse Drug Reaction]
  • isoniazid/cb [Drug Combination]
  • isoniazid/dt [Drug Therapy]
  • kanamycin/ae [Adverse Drug Reaction]
  • kanamycin/cb [Drug Combination]
  • kanamycin/dt [Drug Therapy]
  • lamivudine plus nevirapine plus stavudine/ae [Adve
  • lamivudine plus nevirapine plus stavudine/dt [Drug
  • lamivudine plus nevirapine plus zidovudine/ae [Adv
  • lamivudine plus nevirapine plus zidovudine/dt [Dru
  • levofloxacin/ae [Adverse Drug Reaction]
  • levofloxacin/cb [Drug Combination]
  • levofloxacin/dt [Drug Therapy]
  • lung tuberculosis/dt [Drug Therapy]
  • male
  • mental disease/si [Side Effect]
  • mixed infection
  • mortality
  • moxifloxacin/ae [Adverse Drug Reaction]
  • moxifloxacin/cb [Drug Combination]
  • moxifloxacin/dt [Drug Therapy]
  • multidrug resistant tuberculosis/dt [Drug Therapy]
  • nephrotoxicity/si [Side Effect]
  • nonnucleoside reverse transcriptase inhibitor/dt [
  • ofloxacin
  • patient compliance
  • patient referral
  • peripheral neuropathy/si [Side Effect]
  • proteinase inhibitor/cb [Drug Combination]
  • proteinase inhibitor/dt [Drug Therapy]
  • psychosis/si [Side Effect]
  • pyrazinamide/ae [Adverse Drug Reaction]
  • pyrazinamide/cb [Drug Combination]
  • pyrazinamide/dt [Drug Therapy]
  • quinoline derived antiinfective agent/dt [Drug The
  • retrospective study
  • rifampicin/dt [Drug Therapy]
  • school child
  • streptomycin
  • unclassified drug
  • unspecified side effect/si [Side Effect]

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Authors

  • Isaakidis P.

  • Paryani R.

  • Khan S.

  • Mansoor H.

  • Manglani M.

  • Valiyakath A.

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