Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda.
Makerere University Lung Institute, Kampala, Uganda.
HIV Med. 2023 Mar;24(3):335-343. doi: 10.1111/hiv.13392. Epub 2022 Aug 22.
Our objective was to determine associations between early (≤2 months) culture conversion (ECC) among people with HIV and drug-resistant tuberculosis (DRTB) in Uganda.
This was a countrywide retrospective cohort of people with bacteriologically confirmed DRTB and a positive baseline culture at 16 centres in Uganda between 2013 and 2019. Data were abstracted from treatment files and unit DRTB registers. Monthly sputum cultures were performed using the Lowenstein-Jensen solid medium.
We included 664 people with DRTB and a positive baseline culture, of whom 353 (53.4%) also had HIV. Among those living with HIV, 225 (63.7%) were male and 331 (94.3%) were on antiretroviral therapy. The median month of culture conversion was 2 (interquartile range [IQR] 1-3). ECC was observed among 226 people living with HIV (64.0%; 95% confidence interval [CI] 58.9-68.9). A DRTB treatment regimen of six or more drugs was associated with ECC among people living with HIV (adjusted odds ratio [aOR] 3.82; 95% CI 1.06-13.82; p = 0.041). Cure and overall treatment success was observed among 232 (65.7%) and 269 (76.2%) people living with HIV, respectively. However, ECC was not associated with cure (crude odds ratio [OR] 0.97; 95% CI 0.61-1.54; p = 0.901), death (OR 1.12; 95% CI 0.61-2.29; p = 0.610), or overall treatment success (OR 1.29; 95% CI 0.78-2.13; p = 0.326).
The majority of people living with HIV and DRTB achieve ECC. However, ECC does not predict cure, death, or treatment success. Moreover, it may require six or more drugs to achieve ECC. ECC is not an excellent indicator of the effectiveness of DRTB regimens among people living with HIV.
本研究旨在确定乌干达艾滋病毒感染者中早期（≤2 个月）培养转换（ECC）与耐药性结核病（DRTB）之间的关联。
这是一项在乌干达全国范围内进行的回顾性队列研究，纳入了 2013 年至 2019 年间在 16 个中心确诊为 DRTB 且基线培养阳性的患者。数据从治疗档案和单位 DRTB 登记册中提取。每月使用 Lowenstein-Jensen 固体培养基进行痰培养。
我们纳入了 664 名患有 DRTB 和基线培养阳性的患者，其中 353 名（53.4%）也患有 HIV。在 HIV 感染者中，225 名（63.7%）为男性，331 名（94.3%）接受了抗逆转录病毒治疗。培养转换的中位时间为 2 个月（四分位间距 [IQR] 1-3）。在 353 名 HIV 感染者中，226 名（64.0%；95%置信区间 [CI] 58.9-68.9）实现了 ECC。对于 HIV 感染者，接受 6 种或更多药物的 DRTB 治疗方案与 ECC 相关（调整优势比 [aOR] 3.82；95%CI 1.06-13.82；p=0.041）。分别有 232 名（65.7%）和 269 名（76.2%）HIV 感染者达到了治愈和总体治疗成功。然而，ECC 与治愈（粗比值比 [OR] 0.97；95%CI 0.61-1.54；p=0.901）、死亡（OR 1.12；95%CI 0.61-2.29；p=0.610）或总体治疗成功（OR 1.29；95%CI 0.78-2.13；p=0.326）无关。
大多数 HIV 感染者和 DRTB 患者可实现 ECC。然而，ECC 并不能预测治愈、死亡或治疗成功。此外，实现 ECC 可能需要 6 种或更多的药物。ECC 不是 HIV 感染者 DRTB 方案有效性的一个优秀指标。
