Time to ART Initiation among Patients Treated for Rifampicin-Resistant Tuberculosis in Khayelitsha, South Africa: Impact on Mortality and Treatment Success

Khayelitsha, South Africa, with high burdens of rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection. To describe time to antiretroviral treatment (ART) initiation among HIV-infected RR-TB patients initiating RR-TB treatment and to assess the association between time to ART initiation and...

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Published in:PloS one 2015-11, Vol.10 (11), p.e0142873-e0142873
Main Authors: Daniels, Johnny Flippie, Khogali, Mohammed, Mohr, Erika, Cox, Vivian, Moyo, Sizulu, Edginton, Mary, Hinderaker, Sven Gudmund, Meintjes, Graeme, Hughes, Jennifer, De Azevedo, Virginia, van Cutsem, Gilles, Cox, Helen Suzanne
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adolescent
Adult
AIDS
AIDS-Related Opportunistic Infections - complications
AIDS-Related Opportunistic Infections - drug therapy
AIDS-Related Opportunistic Infections - mortality
Anti-HIV Agents - administration & dosage
Antiretroviral agents
Antiretroviral drugs
Antitubercular Agents - therapeutic use
CD4 antigen
Child
Child, Preschool
Drug therapy
Female
Highly active antiretroviral therapy
HIV
HIV infections
Human immunodeficiency virus
Humans
Infant
Infant, Newborn
Infections
Male
Medical diagnosis
Methods
Mortality
Multidrug resistance
Patients
Pharmacological research
Physiological aspects
Precision medicine
Rifampin
Rifampin - therapeutic use
South Africa
Systematic review
Treatment Outcome
Tuberculosis
Tuberculosis, Multidrug-Resistant - complications
Tuberculosis, Multidrug-Resistant - drug therapy
Tuberculosis, Multidrug-Resistant - mortality
Young Adult
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Summary:Khayelitsha, South Africa, with high burdens of rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection. To describe time to antiretroviral treatment (ART) initiation among HIV-infected RR-TB patients initiating RR-TB treatment and to assess the association between time to ART initiation and treatment outcomes. A retrospective cohort study of patients with RR-TB and HIV co-infection not on ART at RR-TB treatment initiation. Of the 696 RR-TB and HIV-infected patients initiated on RR-TB treatment between 2009 and 2013, 303 (44%) were not on ART when RR-TB treatment was initiated. The median CD4 cell count was 126 cells/mm3. Overall 257 (85%) patients started ART during RR-TB treatment, 33 (11%) within 2 weeks, 152 (50%) between 2-8 weeks and 72 (24%) after 8 weeks. Of the 46 (15%) who never started ART, 10 (21%) died or stopped RR-TB treatment within 4 weeks and 16 (37%) had at least 4 months of RR-TB treatment. Treatment success and mortality during treatment did not vary by time to ART initiation: treatment success was 41%, 43%, and 50% among patients who started ART within 2 weeks, between 2-8 weeks, and after 8 weeks (p = 0.62), while mortality was 21%, 13% and 15% respectively (p = 0.57). Mortality was associated with never receiving ART (adjusted hazard ratio (aHR) 6.0, CI 2.1-18.1), CD4 count ≤100 (aHR 2.1, CI 1.0-4.5), and multidrug-resistant tuberculosis (MDR-TB) with second-line resistance (aHR 2.5, CI 1.1-5.4). Despite wide variation in time to ART initiation among RR-TB patients, no differences in mortality or treatment success were observed. However, a significant proportion of patients did not initiate ART despite receiving >4 months of RR-TB treatment. Programmatic priorities should focus on ensuring all patients with RR-TB/HIV co-infection initiate ART regardless of CD4 count, with special attention for patients with CD4 counts ≤ 100 to initiate ART as soon as possible after RR-TB treatment initiation.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0142873