Treatment outcomes in patients infected with multidrug resistant tuberculosis and in patients with multidrug resistant tuberculosis coinfected with human immunodeficiency virus at Brewelskloof Hospital

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dc.contributor.advisorMugabo, P.
dc.contributor.advisorTheron, Dan
dc.contributor.advisorBradley, Hazel
dc.contributor.authorAdewumi, Olayinka Anthony
dc.contributor.otherSchool of Pharmacy
dc.date.accessioned2014-03-13T11:59:30Z
dc.date.accessioned2024-05-15T07:43:09Z
dc.date.available2013/08/08
dc.date.available2013/08/08 16:22
dc.date.available2014-03-13T11:59:30Z
dc.date.available2024-05-15T07:43:09Z
dc.date.issued2012
dc.descriptionMagister Pharmaceuticae - MPharmen_US
dc.description.abstractMany studies have reported low cure rates for multidrug-resistant tuberculosis (MDRTB) patients and MDR-TB patients co-infected with human immunodeficiency virus (HIV). However, little is known about the effect of HIV infection and antiretroviral therapy on the treatment outcomes of MDR-TB in South Africa. Therefore, the objectives of the study are: to find out whether HIV infection and interactions between ARVs and second line anti-TB drugs have an impact on the following MDR-TB treatment outcomes: cure rate and treatment failure at Brewelskloof Hospital. MDR-TB patients were treated for 18-24 months. The study was designed as a case-control retrospective study comparing MDR-TB treatment outcomes between HIV positive (cases) and HIV negative patients (controls). Patients were included in the study only if they complied with the following criteria: sensitivity to second line anti-TB drugs, MDR-TB infection, co-infection with HIV (for some of them), male and female patients, completion of treatment between 1 January 2006 and 31 December 2008. Any patients that presented with extreme drug-resistant tuberculosis (XDR-TB) were excluded from the study. Data were retrospectively collected from each patient’s medical records. There were a total of 336 patients of which 242 (72%) were MDR-TB patients and 94 (27.9%) MDRTB co-infected with HIV patients. Out of the 242 MDR-TB patients, 167 (69.2%) were males and 75 (30.7%) were females. Of the 94 patients with MDR-TB co-infected with HIV, 51 (54.2%) males and 43 (45.7%) females. Patients with multidrug-resistant tuberculosis co-infected with HIV who qualify for antiretroviral therapy were treated with stavudine, lamivudine and efavirenz while all MDR-TB patients were given kanamycin, ethionamide, ofloxacin, cycloserine and pyrazinamide. The cure rate of MDR-TB in HIV (+) patients and in HIV (-) patients is 34.5% and 30 % respectively. There is no significant difference between both artes (pvalue = 0.80). The MDR-TB cure rate in HIV (+) patients taking antiretroviral drugs and in HIV (+) patients without antiretroviral therapy is 35% and 33% respectively. The difference between both rates is not statistically significant. The study shows that 65 (28.0%) patients completed MDR-TB treatment but could not be classified as cured or failure, 29 (12.5%) patients failed, 76 (32.7%) defaulted, 18 (7.7%) were transferred out and 44 (18.9%) died. As far as treatment completed and defaulted is concerned, there is no significant statistical difference between HIV (+) and HIV (-) The number of patients who failed the MDR-TB treatment and who were transferred out is significantly higher in the HIV (-) group than in the HIV (+) group. Finally the number of MDR-TB patients who died is significantly higher in the HIV (+) group). The median (range) duration of antiretroviral therapy before starting anti-tuberculosis drugs is 10.5 (1-60) months. According to this study results, the MDR-TB treatment cure rate at Brewelkloof hospital is similar to the cure rate at the national level. The study also hows that HIV infection and antiretroviral drugs do not influence any influence on MDR-TB treatment outcomes.en_US
dc.description.countrySouth Africa
dc.identifier.urihttps://hdl.handle.net/10566/15198
dc.language.isoenen_US
dc.publisherUniversity of the Western Capeen_US
dc.rights.holderCopyright: University of the Western Capeen_US
dc.subjectAntitubercular agentsen_US
dc.subjectDrug interactionsen_US
dc.subjectTreatment outcomesen_US
dc.subjectMycobacterium tuberculosisen_US
dc.subjectHuman immunodeficiency virusen_US
dc.subjectMultidrug-resistant tuberculosisen_US
dc.subjectAntiretroviral agentsen_US
dc.titleTreatment outcomes in patients infected with multidrug resistant tuberculosis and in patients with multidrug resistant tuberculosis coinfected with human immunodeficiency virus at Brewelskloof Hospitalen_US

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