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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

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.


Journal Identifiers


eISSN: 2078-6751
print ISSN: 1608-9693