Table 4:
Comparison of clinical and treatment factors associated with early and late deaths among the HIV-positive population with multidrug-resistant tuberculosis
| Survived (n=2013) |
Early death: died within 3 months (n=291) |
Late death: died after 3 months (n=544) |
aOR (95% CI) for early death vs survival |
aOR (95% CI) for late death vs survival |
|
|---|---|---|---|---|---|
| Clinical characteristics | |||||
| Mean age, years (SD) | 36·6 (9·1) | 37·3 (10·2) | 36·3 (9·0) | 1·01 (1·00–1·03) | 0·99 (0·98–1·00) |
| Sex | |||||
| Male | 1049 (52%) | 137 (47%) | 263 (48%) | 1 (ref) | 1 (ref) |
| Female | 964 (48%) | 154 (53%) | 280 (52%) | 1·24 (0·95–1·61) | 1·04 (0·85–1·28) |
| Acid-fast bacilli smear status | |||||
| Negative | 674 (34%) | 82 (29%) | 171 (32%) | 1 (ref) | 1 (ref) |
| Positive | 1330 (66%) | 196 (71%) | 359 (68%) | 1·26 (0·95–1·66) | 0·93 (0·75–1·16) |
| Previous tuberculosis treatment | |||||
| No or unknown | 902 (45%) | 128 (44%) | 155 (28%) | 1 (ref) | 1 (ref) |
| Previous first-line tuberculosis drugs | 853 (42%) | 108 (37%) | 123 (23%) | 0·96 (0·70–1·32) | 1·56 (1·22–2·00) |
| Previous second-line tuberculosis drugs | 258 (13%) | 55 (19%) | 266 (49%) | 0·98 (0·63–1·52) | 1·67 (1·20–2·35) |
| Drug resistance profile of tuberculosis* | |||||
| Multidrug resistant, without fluoroquinolone or second-line injectable resistance | 1331 (68%) | 161 (56%) | 275 (52%) | 1 (ref) | 1 (ref) |
| Multidrug resistant, fluoroquinolone susceptible with any second-line injectable resistance | 164 (8%) | 12 (4%) | 53 (10%) | 0·62 (0·34–1·15) | 1·52 (1·07–2·15) |
| Multidrug resistant, fluoroquinolone resistant without any second-line injectable resistance | 135 (7%) | 18 (6%) | 27 (5%) | 1·04 (0·60–1·79) | 1·00 (0·63–1·57) |
| Extensively drug resistant, with both fluoroquinolone and any second-line injectable resistance | 330 (17%) | 96 (33%) | 170 (32%) | 1·54 (1·01–2·26) | 1·34 (0·99–1·84) |
| Treatment characteristics | |||||
| ART not used | 210 (10%) | 84 (29%) | 109 (20%) | 1 (ref) | 1 (ref) |
| ART used | 1803 (90%) | 207 (71%) | 435 (80%) | 0·18 (0·12–0·26) | 0·71 (0·51–0·99) |
| Number of effective Group A drugs used | |||||
| 0 | 349 (17%) | 102 (35%) | 223 (41%) | 1 (ref) | 1 (ref) |
| 1 | 1044 (52%) | 156 (54%) | 237 (44%) | 0·46 (0·29–0·73) | 0·61 (0·42–0·91) |
| 2 or more | 620 (31%) | 33 (11%) | 84 (15%) | 0·17 (0·10–0·30) | 0·37 (0·24–0·57) |
| Number of effective Group B or C drugs use† | |||||
| 0–1 | 301 (15%) | 71 (24%) | 114 (21%) | 1 (ref) | 1 (ref) |
| 2–3 | 1300 (65%) | 185 (64%) | 315 (58%) | 0·79 (0·53–1·18) | 0·89 (0·62–1·27) |
| 4 or more | 412 (20%) | 35 (12%) | 115 (21%) | 0·47 (0·22–0·98) | 0·76 (0·45–1·29) |
Data are n (%), unless otherwise specified. Percentages might not add up to 100% due to rounding. ART treatment subgroups were considered together, with adjustment for ART. Only patients with a known outcome date were included. Survived combined success and failure. Losses to follow-up were excluded. All estimates from random effect models, binomial family, adjusted for age, sex, past tuberculosis treatment, acid-fast bacilli smear status, and resistance to second-line injectables and fluoroquinolones plus year tuberculosis treatment started and World Bank Income classification. Missing acid-fast bacilli smear for 9 patients of survived group, 14 patients in the late death group, and 13 in the early death group. Missing drug-susceptibility testing results for drug resistance profile in 53 patients in survived group, 19 in the late death group, and 4 in the early death group. Sex information missing in one patient in the late death group. Percentages presented in table refer to those with information available. Group A drugs were bedaquiline, moxifloxacin, levofloxacin, and linezolid. Group B drugs were clofazimine, cycloserine, or terizidone. Group C drugs were ethambutol, pyrazinamide, delamanid, amikacin-streptomycin, ethionamide-protionamide, and para-aminosalicylic acid. ART=antiretroviral therapy. aOR=adjusted odds ratio.
Same as base model, except for drug resistance profile.
Same as base model, except estimates for number of effective drugs in Group A or Groups B and C were adjusted for each other, in the same model and for ART use. The use of ofloxacin, ciprofloxacin, and gatifloxacin was included in Groups B and C.