Serious treatment related adverse drug reactions amongst anti-retroviral naïve MDR-TB patients

Martha Van der Walt, Johanna Lancaster, Ronel Odendaal, Jeanne Garcia Davis, Karen Shean, Jason Farley, Martha Van der Walt, Johanna Lancaster, Ronel Odendaal, Jeanne Garcia Davis, Karen Shean, Jason Farley

Abstract

Background: Globally treatment outcomes for multidrug-resistant Mycobacterium tuberculosis (MDR-TB) remain poor and this is compounded by high drug toxicity. Little is known about the influence of adverse drug reactions (ADRs) on treatment outcomes in South Africa.

Methods: We evaluated the impact of severe ADRs among a prospective cohort of MDR-TB patients in South Africa (2000-2004). The HIV-infected study participants were anti-retroviral naïve.

Results: Of 2,079 patients enrolled, 1,390 (66.8%) were included in this analysis based on known HIV test results (39.1% HIV-infected). At least one severe ADR was reported in 83 (6.9%) patients with ototoxicity being the most frequent ADR experienced (38.9%).

Conclusions: We found that being HIV-infected but antiretroviral naïve did not increase occurrence of SADRs in patients on second-line anti-tuberculosis drugs. Early screening and proactive management of ADRs in this patient population is essential, especially given the rollout of decentralized care and the potential for overlapping toxicity of concomitant MDR-TB and HIV treatment.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Study plan stratified by HIV…
Figure 1. Study plan stratified by HIV status.

References

    1. Orenstein EW, Basu S, Shah NS, Andrews JR, Friedland GH, et al. (2009) Treatment outcomes among patients with multidrug-resistant tuberculosis: Systematic review and meta-analysis. Lancet Infect Dis 9: 153–161.
    1. Sterling TR, Pham PA, Chaisson RE (2010) HIV infection-related tuberculosis: Clinical manifestations and treatment. Clin Infect Dis, Suppl 3: S223–S230.
    1. Scano F, Vitoria M, Burman W, Harries AD, Gilks C F, et al. (2008) Management of HIV-infected patients with MDR- and XDR-TB in resource-limited settings. Int J Tuberc Lung Dis 12: 1370–1375.
    1. World Health Organisation (2008) Guidelines for the programmatic management of drug- resistant tuberculosis: Emergency update 2008. World Health Organisation: Geneva.
    1. Shean KP, Willcox PA, Siwendu SN, Laerson KF, Gross L (2008) Treatment outcome and follow-up of multidrug-resistant tuberculosis patients, West Coast/Winelands, South Africa, 1992-2002. Int J Tuberc Lung Dis 12: 1182–1189.
    1. Bloss E, Kuksa L, Holtz TH, Riekstina V, Skripconoka V, et al. (2010) Adverse events related to multidrug-resistant tuberculosis treatment, Latvia, 2000–2004. Int J Tuberc Lung Dis 14: 275–281.
    1. Nathanson E, Gupta R, Huamani P, Leimane V, Pasechnikov AD, et al. (2004) Adverse events in the treatment of multidrug-resistant tuberculosis: results from the DOTS-Plus initiative. Int J Tuberc Lung Dis 8: 1382–1384.
    1. Shin SS, Pasechnikov AD, Gelmanova IY, Peremitin GG, Strelis AK, et al. (2007) Adverse reactions among patients being treated for MDR-TB in Tomsk, Russia. Int J Tuberc Lung Dis 11: 1314–1320.
    1. World Health Organisation (2010) Global Tuberculosis Control report.
    1. South African Medical Research Council and the DOTS-plus Study Group of South Africa (2000) DOTS-Plus for multi-drug resistant tuberculosis patients in South Africa – Systemic evaluation of a standarised treatment regimen applied under tuberculosis control programme conditions.
    1. Weyer K, Brand J, Lancaster J, Levin J, van der Walt M (2007) Determinants of multidrug-resistant tuberculosis in South Africa: results from a national survey. SA Medical Journal 97: 1120–1128.
    1. National Department of Health SA (2010) The South African Antiretroviral Treatment Guidelines 2.
    1. Farley JE, Ram M, Pan W, Waldman S, Cassell GH, et al. (2011) Outcomes of Multi-Drug Resistant Tuberculosis (MDR-TB) among a Cohort of South African Patients with High HIV Prevalence. PLOSone 6 1–7.
    1. Torun T, Gungor G, Ozmen I, Sevim T, Tahaoglu K, et al. (2005) Side effects associated with the treatment of multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 9: 1373–1377.
    1. Sagwa E, Mantel-Teeuwisse AK, Ruswa N, Musasa JP, Pal S, et al. (2012) The burden of adverse events during treatment of drug-resistant tuberculosis in Namibia. Southern Med Review Vol 5.

Source: PubMed

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