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

Autor:	Campbell JR; Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada jonathon.campbell@mcgill.ca.; Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.; Montreal Chest Institute & McGill International TB Centre, McGill University, Montreal, Quebec, Canada., Brode SK; West Park Healthcare Centre, Toronto, Ontario, Canada.; Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Barry P; Tuberculosis Control Branch, California Department of Public Health, Richmond, California, USA., Bastos ML; Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada., Bonnet M; University of Montpellier, Montpellier, France., Guglielmetti L; Immunology and Infectious Diseasese, Sorbonne Universite, Paris, France., Kempker R; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA., Klimuk D; Republican Scientific and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus., Laniado Laborín R; Facultad de Medicina, Universidad Autónoma de Baja California, Mexicali, Mexico., Milanov V; Occupational Diseases, Medical University-Sofia, Sofia, Bulgaria., Singla R; Tuberculosis and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India., Skrahina A; Republican Scientific and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus., Trajman A; Montreal Chest Institute & McGill International TB Centre, McGill University, Montreal, Quebec, Canada.; Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil., van der Werf TS; Departments of Internal Medicine, Infectious Diseases, Pulmonary Diseases, and Tuberculosis, UMC Groningen, Groningen, The Netherlands., Viiklepp P; Department of Registries, National Institute for Health Development, Tallinn, Estonia., Menzies D; Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.; Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.; Montreal Chest Institute & McGill International TB Centre, McGill University, Montreal, Quebec, Canada.
Jazyk:	angličtina
Zdroj:	Thorax [Thorax] 2024 Jan 18; Vol. 79 (2), pp. 169-178. Date of Electronic Publication: 2024 Jan 18.
DOI:	10.1136/thorax-2023-220249
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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