Original Research

Rifampicin resistance and mortality in patients hospitalised with HIV-associated tuberculosis

Ruan Spies, Charlotte Schutz, Amy Ward, Avuyonke Balfour, Muki Shey, Mark Nicol, Rosie Burton, Bianca Sossen, Robert Wilkinson, David Barr, Graeme Meintjes
Southern African Journal of HIV Medicine | Vol 23, No 1 | a1396 | DOI: https://doi.org/10.4102/sajhivmed.v23i1.1396 | © 2022 Ruan Spies, Charlotte Schutz, Amy Ward, Avuyonke Balfour, Muki Shey, Mark Nicol, Rosie Burton, Bianca Sossen, Robert Wilkinson, David Barr, Graeme Meintjes | This work is licensed under CC Attribution 4.0
Submitted: 25 April 2022 | Published: 27 September 2022

About the author(s)

Ruan Spies, Department of Medicine, New Somerset Hospital, Cape Town, South Africa
Charlotte Schutz, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Amy Ward, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Avuyonke Balfour, Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Muki Shey, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Mark Nicol, Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia
Rosie Burton, Médecins sans Frontières, Cape Town, South Africa
Bianca Sossen, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Robert Wilkinson, Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, The Francis Crick Institute, London, United Kingdom; and, Department of Infectious Disease, University College London, London, United Kingdom
David Barr, Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
Graeme Meintjes, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa


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Abstract

Background: Patients with HIV and drug-resistant tuberculosis (TB) are at high risk of death.

Objectives: We investigated the association between rifampicin-resistant TB (RR-TB) and mortality in a cohort of patients who were admitted to hospital at the time of TB diagnosis.

Method: Adults hospitalised at Khayelitsha Hospital and diagnosed with HIV-associated TB during admission, were enrolled between 2013 and 2016. Clinical, biochemical and microbiological data were prospectively collected and participants were followed up for 12 weeks.

Results: Participants with microbiologically confirmed TB (n = 482) were enrolled a median of two days (interquartile range [IQR]: 1–3 days) following admission. Fifty-three participants (11.0%) had RR-TB. Participants with rifampicin-susceptible TB (RS-TB) received appropriate treatment a median of one day (IQR: 1–2 days) following enrolment compared to three days (IQR: 1–9 days) in participants with RR-TB. Eight participants with RS-TB (1.9%) and six participants with RR-TB (11.3%) died prior to the initiation of appropriate treatment. Mortality at 12 weeks was 87/429 (20.3%) in the RS-TB group and 21/53 (39.6%) in the RR-TB group. RR-TB was a significant predictor of 12-week mortality (hazard ratio: 1.88; 95% confidence interval: 1.07–3.29; P = 0.03).

Conclusion: Mortality at 12 weeks in participants with RR-TB was high compared to participants with RS-TB. Delays in the initiation of appropriate treatment and poorer regimen efficacy are proposed as contributors to higher mortality in hospitalised patients with HIV and RR-TB.


Keywords

HIV-associated tuberculosis; rifampicin-resistant tuberculosis; drug-resistant tuberculosis; multi-drug resistant TB; TB; Khayelitsha Hospital

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