CCEB Impact of HIV on Early MDR-TB Treatment Outcomes in Botswana Jeffrey Hafkin MD Botswana-UPenn Partnership Center for Clinical Epidemiology and Biostatistics Infectious Disease Division, Department of Medicine University of Pennsylvania School of Medicine
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CCEB Impact of HIV on Early MDR- TB Treatment Outcomes in Botswana Jeffrey Hafkin MD Botswana-UPenn Partnership Center for Clinical Epidemiology and Biostatistics.
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CCEB
Impact of HIV on Early MDR-TB Treatment Outcomes in
Botswana
Jeffrey Hafkin MD
Botswana-UPenn PartnershipCenter for Clinical Epidemiology and Biostatistics
Infectious Disease Division, Department of MedicineUniversity of Pennsylvania School of Medicine
CCEB
Background: MDR-TB and HIV-infection
• In the pre-HAART era, MDR-TB with HIV infection had worse treatment response and higher mortality compared to HIV-uninfected MDR-TB
• Few studies of MDR-TB outcomes in HIV+ with access to HAART, particularly in sub-Saharan Africa
Seung et al. PloS One 2009Brust et al. PloS One 2011
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Background: Epidemiology of HIV and TB in Botswana
• Prevalence of HIV infection = 25% (UNAIDS 2009)
• Incidence of TB disease = 503 cases per 100,000 population (WHO 2010)
• Prevalence of MDR-TB during 1995-2008:– 0.2% to 3.4% (treatment naïve)– 6.1% to 13.1% (treatment experienced)
• Start of HAART roll-out in Botswana in 2003
Nelson et al. Lancet 2005WHO. M/XDR-TB: 2010 global report on surveillance and response
– Botswana vs. Sub-Saharan Africa• Selection bias:
– Specialist care in a referral center– Missing culture/DST data
• Misclassification bias:– Characterization of toxicity
• Unmeasured confounding
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Conclusions
• HIV infection did not impact time to culture conversion in cohort of adults with MDR-TB from Botswana
• Suggests that in resource-limited settings with broad access to ART and individualized MDR-TB care, short term microbiologic outcomes may be comparable in HIV-infected and uninfected patients
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Conclusions
• Furthermore, high rates of drug toxicity overall and more likely to be associated with co-infection
CCEB
Acknowledgements
• Univ of Pennsylvania– Chawanga Modongo– Lephata Molopisi– Craig Newcomb– Elizabeth Lowenthal– Andrew Steinhoff– Rob Roy MacGregor– Harvey Friedman– Gregory Bisson