Association of indicators of extensive disease and rifampin-resistant tuberculosis treatment outcomes: An individual participant data meta-analysis

Jonathon R. Campbell, Sarah K. Brode, Pennan Barry, Mayara Lisboa Bastos, Maryline Bonnet, Lorenzo Guglielmetti, Russell Kempker, Dzmitry Klimuk, Rafael Laniado Laborín, Vladimir Milanov, Rupak Singla, Alena Skrahina, Anete Trajman, Tjip S. Van Der Werf, Piret Viiklepp, Dick Menzies

OnderzoeksoutputAcademicpeer review


Background Indicators of extensive disease - acid fast bacilli (AFB) smear positivity and lung cavitation - have been inconsistently associated with clinical rifampin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB) outcomes. We evaluated the association of these indicators with end-of-treatment outcomes. Methods We did an individual participant data meta-analysis of people treated for RR/MDR-TB with longer regimens with documented AFB smear and chest radiography findings. We compared people AFB smear-negative without cavities to people: (1) smear-negative with lung cavities; (2) smear-positive without lung cavities and (3) AFB smear-positive with lung cavities. Using multivariable logistic regression accounting for demographic, treatment and clinical factors, we calculated adjusted ORs (aOR) for any unfavourable outcome (death, lost to follow-up, failure/recurrence), and mortality and treatment failure/recurrence alone. Results We included 5596 participants; included participants significantly differed from excluded participants. Overall, 774 (13.8%) were AFB smear-negative without cavities, 647 (11.6%) only had cavities, 1424 (25.4%) were AFB smear-positive alone and 2751 (49.2%) were AFB smear-positive with cavities. The median age was 37 years (IQR: 28-47), 3580 (64%) were male and 686 (12.5%) had HIV. Compared with participants AFB smear-negative without cavities, aOR (95% CI) for any unfavourable outcome was 1.0 (0.8 to 1.4) for participants smear-negative with lung cavities, 1.2 (0.9 to 1.5) if smear-positive without cavities and 1.6 (1.3 to 2.0) if AFB smear-positive with lung cavities. Odds were only significantly increased for mortality (1.5, 95% CI 1.1 to 2.1) and failure/recurrence (2.2, 95% CI 1.5 to 3.3) among participants AFB smear-positive with lung cavities. Conclusion Only the combination of AFB smear-positivity and lung cavitation was associated with unfavourable outcomes, suggesting they may benefit from stronger regimens.

Originele taal-2English
Pagina's (van-tot)169-178
Aantal pagina's10
Nummer van het tijdschrift2
StatusPublished - 18-jan.-2024

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