Araújo-Pereira Mariana, Arriaga María B, Carvalho Anna Cristina C, Spener-Gomes Renata, Schmaltz Carolina A S, Nogueira Betânia M F, Figueiredo Marina C, Turner Megan M, Cordeiro-Santos Marcelo, Rolla Valeria C, Sterling Timothy R, Andrade Bruno B, Kritski Afrânio L
Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil.
Open Forum Infect Dis. 2024 Jan 8;11(1):ofad691. doi: 10.1093/ofid/ofad691. eCollection 2024 Jan.
The high burden of drug-resistant tuberculosis (TB) is a problem to achieve the goals of the End TB Strategy by 2035. Whether isoniazid monoresistance (Hr) affects anti-TB treatment (ATT) outcomes remains unknown in high-burden countries.
We evaluated determinants of ATT outcome among pulmonary TB cases reported to the National Notifiable Disease Information System (SINAN) between June 2015 and June 2019, according to drug sensitivity testing (DST) results. Binomial logistic regression models were employed to evaluate whether Hr was associated with an unfavorable ATT outcome: death or failure, compared to cure or treatment completion.
Among 60 804 TB cases reported in SINAN, 21 197 (34.9%) were included in the study. In this database, the frequency of unfavorable outcomes was significantly higher in those with Hr in contrast to isoniazid-sensitive persons with pulmonary TB (9.1% vs 3.05%; < .001). Using a binomial logistic regression model, Hr was independently associated with unfavorable outcomes (odds ratio, 3.34 [95% confidence interval, 2.06-5.40]; < .001).
Hr detected prior to ATT was predictive of unfavorable outcomes at the national level in Brazil. Our data reinforce the need for high-TB-burden countries to prioritize DST to detect Hr. Effective treatment regimens for Hr-TB are needed to improve outcomes.
耐多药结核病的高负担是实现2035年终结结核病战略目标的一个问题。在高负担国家，异烟肼单耐药（Hr）是否会影响抗结核治疗（ATT）结果仍不清楚。
我们根据药敏试验（DST）结果，评估了2015年6月至2019年6月期间向国家法定传染病信息系统（SINAN）报告的肺结核病例中ATT结果的决定因素。采用二项逻辑回归模型评估Hr与不良ATT结果（死亡或治疗失败）是否相关，与治愈或完成治疗相比。
在SINAN报告的60804例结核病病例中，21197例（34.9%）纳入研究。在该数据库中，与异烟肼敏感的肺结核患者相比，Hr患者的不良结果发生率显著更高（9.1%对3.05%；P<0.001）。使用二项逻辑回归模型，Hr与不良结果独立相关（比值比，3.34[95%置信区间，2.06-5.40]；P<0.001）。
在巴西，ATT前检测到的Hr可预测国家层面的不良结果。我们的数据强化了高结核病负担国家将DST作为优先事项以检测Hr的必要性。需要有效的耐异烟肼结核病治疗方案来改善治疗结果。
