Isoniazid-monoresistant tuberculosis is associated with poor treatment outcomes in Durban, South Africa
OBJECTIVE: To determine the association between isoniazid (INH) monoresistant TB and treatment outcomes.
DESIGN: We performed a retrospective longitudinal study of patients seen from 2000 to 2012 to compare episodes of INH-monoresistant TB with those of drug-susceptible TB using logistic regression with robust standard errors. INH-monoresistant TB was treated with modified regimens.
RESULTS: Among 18 058 TB patients, there were 19 979 TB episodes for which drug susceptibility testing was performed. Of these, 557 were INH-monoresistant and 16 311 were drug-susceptible. Loss to follow-up, transfer, and human immunodeficiency virus (HIV) co-infection (41% had known HIV status) were similar between groups. INH-monoresistant episodes were more likely to result in treatment failure (4.1% vs. 0.6%, P < 0.001) and death (3.2% vs. 1.8%, P = 0.01) than drug-susceptible episodes. After adjustment for age, sex, race, retreatment status, and disease site, INH-monoresistant episodes were more likely to have resulted in treatment failure (OR 6.84, 95%CI 4.29–10.89, P < 0.001) and death (OR 1.81, 95%CI 1.11–2.95, P = 0.02).
CONCLUSION: INH monoresistance was associated with worse clinical outcomes than drug-susceptible TB. Our findings support the need for rapid diagnostic tests for INH resistance and improved treatment regimens for INH-monoresistant TB.
Document Type: Research Article
Affiliations: 1: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA 2: KwaZulu-Natal Research Institute for TB and HIV, Durban 3: eThekwini Municipality, Durban, South Africa 4: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA 5: Department of Infectious Diseases, Division of Internal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
Publication date: June 1, 2017
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