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Home / The International Journal of Tuberculosis and Lung Disease, Volume 27, Number 6

Smoked drug use in patients with TB is associated with higher bacterial burden

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BACKGROUND: Smoking of illicit drugs may lead to more rapid TB disease progression or late treatment presentation, yet research on this topic is scant. We examined the association between smoked drug use and bacterial burden among patients newly initiated on drug-susceptible TB (DS-TB) therapy.

METHODS: Data from 303 participants initiating DS-TB treatment in the Western Cape Province, South Africa, were analyzed. Smoked drug use was defined as self-reported or biologically verified methamphetamine, methaqualone and/or cannabis use. Proportional hazard and logistic regression models (adjusted for age, sex, HIV status and tobacco use) examined associations between smoked drug use and mycobacterial time to culture positivity (TTP), acid-fast bacilli sputum smear positivity and lung cavitation.

RESULTS: People who smoked drugs (PWSD) comprised 54.8% (n = 166) of the cohort. TTP was faster for PWSD (hazard ratio 1.48, 95% CI 1.10–1.97; P = 0.008). Smear positivity was higher among PWSD (OR 2.28, 95% CI 1.22–4.34; P = 0.011). Smoked drug use (OR 1.08, 95% CI 0.62–1.87; P = 0.799) was not associated with increased cavitation.

CONCLUSIONS: PWSD had a higher bacterial burden at diagnosis than those who do not smoke drugs. Screening for TB among PWSD in the community may facilitate earlier linkage to TB treatment and reduce community transmission.

Keywords: South Africa; bacterial load; drug-susceptible tuberculosis; smoked drug use

Document Type: Research Article

Affiliations: 1: Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia, Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa 2: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa 3: Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA 4: Department of Biostatistics, School of Public Health, Boston University, MA, USA 5: Department of Radiology, Department of Medicine, Boston Medical Center, Boston, MA, USA 6: Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA, Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA 7: Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa 8: Western Cape Department of Health, Pretoria, South Africa 9: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa 10: Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA, Department of Global Health, Boston University School of Public Health, Boston, MA, USA 11: Department of Science and Technology, National Research Foundation Centre of Excellence in Biomedical Tuberculosis Research, South Africa Medical Research Council for Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa

Publication date: June 1, 2023

More about this publication?

  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

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