Tuberculosis recurrence in patients with hiv infection

Objective: to analyze specific characteristics and outcomes of treatment in patients with tuberculosis (TB) coinfected with HIV. Patients and methods. The study included all re-treatment TB patients with HIV-infection (n = 153) registered in Novokuznetsk between 2013 and 2017. The control group comprised all newly diagnosed TB patients with HIV-infection (n = 372) registered between 2013 and 2014. Results. A total of 46.4% of all re-treatment TB cases were HIV/TB cases. Only 18.1% of individuals were adhered to ART at the moment of TB relapse identification. More than two-thirds of study participants (74.7%) had smear-and/or culture-positive TB. Re-treatment TB patients were more likely to have multidrug-resistant TB (MDR-TB) than newly diagnosed TB patients (82.3% vs 51.4%). Moreover, re-treatment TB patients demonstrated significantly lower cure rates than those with newly diagnosed TB (15.1% vs 38.2%). The death rate was 50.3% in the re-treatment group and 40.9% in the group with new TB cases. Death rates among patients defaulted ART (n = 50) were higher than in those receiving ART (n = 13) (62.0% vs 23.1%). Conclusion. The majority of re-treatment TB patients (69.4%) defaulted ART at least 6 months before the identification of TB recurrence. Secondary MDR-TB was observed in 82.3% of patients. The cure rate was significantly lower in re-treatment HIV/TB patients than in newly diagnosed patients (15.1% vs 38.2%). Adherence to ART was the most important factor affecting treatment outcomes in HIV-coinfected re-treatment TB patients. © 2019, Dynasty Publishing House. All rights reserved.