HIV Infection Yields Higher Risk of Complications with Tuberculosis Treatment

Individuals with HIV face more complexities when being treated for tuberculosis (TB), according to a new study published in AIDS Research and Human Retroviruses.

Although HIV/TB coinfection was not associated overall with unfavorable TB outcomes, coinfection appeared to affect TB drug-related adverse events, hospital readmissions, and TB treatment duration.

The study included adults aged 18 years and older with culture-confirmed pulmonary or extrapulmonary TB treated between January 2008 and October 2015. Of the 274 eligible study participants, 35% were HIV-positive, including 76% with known HIV before TB diagnosis and 24% with new HIV diagnosis at the time of TB diagnosis. Among those with HIV/TB coinfection, the median baseline CD4 was 86 cells/mm³ and the median time between baseline CD4 and TB diagnosis was 1 day, according to the study.

The researchers found that 22% of patients had TB treatment interrupted due to 1 or more adverse events, with hepatotoxicity (7%) being the most common reason for drug interruption. The median TB treatment duration was 9.1 months and 12% of patients received more than 12 months of treatment.

Additionally, the study showed that the median duration of hospitalization was 8 days and 13% required intensive care unit admission. Thirty-one percent of patients had more than 1 hospital readmission during TB treatment and 14% were readmitted within 30 days of hospital discharge. Forty-eight percent of all readmissions were TB-related.

According to the study findings:

• There were more treatment interruptions due to adverse events among patients with HIV, including of rifamycins, isoniazid, and pyrazinamide, compared with patients without HIV.
• Patients with HIV received longer median TB treatment compared with patients without HIV.
• Patients with HIV were more likely to be readmitted to the hospital during TB treatment and had a higher 30-day readmission rate.

Regarding treatment outcomes, patients with HIV had a lower proportion of cure and higher proportion of recurrence and death compared with patients without HIV. The study also showed that patients receiving ART during TB treatment had a higher proportion of cure and a lower proportion of death compared with those who did not receive ART. However, HIV infection did not have a significant effect on unfavorable outcomes overall, which the authors attributed to care received from health providers experienced in care for TB/HIV coinfection, individualized treatment for TB and HIV, and use of prophylaxis for opportunistic infections.

According to the researchers, the findings underscore the importance of maintaining resources and expertise to treat coinfected patients in similar settings.

References

Bizune DJ, Kempker RR, Kagei M, et al. Treatment complexities among patients with tuberculosis in a high HIV prevalence cohort in the United States. 2018. https://doi.org/10.1089/aid.2018.0126

Managing the Complexities and Risks of HIV and Tuberculosis Coinfection [news release]. Mary Ann Liebert Inc.’s website. https://home.liebertpub.com/news/managing-the-complexities-and-risks-of-hiv-and-tuberculosis-coinfection/2457. Accessed October 19, 2018.