Lodiong Lodiong Jackson Dumo, Izudi Jonathan, Amos Timbine, Twinomugisha Bright, Kulaba Nicholas, Lumori Boniface Amanee Elias
Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda.
IJID Reg. 2024 Sep 10;13:100438. doi: 10.1016/j.ijregi.2024.100438. eCollection 2024 Dec.
People with drug-resistant tuberculosis (DR-TB) on bedaquiline-containing regimens are at risk for a prolonged corrected QT (QTc) interval but this problem is understudied in low-resource countries. We determined the magnitude and risk factors for QTc interval prolongation among people with DR-TB on bedaquiline-containing regimens at three referral hospitals in Uganda.
Using retrospectively collected data, we designed a matched case-control study, with cases as participants with prolonged QTc interval and controls as those with normal QTc interval in 1:1. QTc interval prolongation was defined as an increase in QTc interval by 60 milliseconds in electrocardiogram from the baseline or ≥500 milliseconds during follow-up for men and women. Factors associated with cases compared with controls were identified using a multivariable conditional regression analysis at a 5% significance level, reported using odds ratio (OR) and the 95% confidence interval (CI).
Of 153 participants, 39 (25.5%) had a prolonged QTc interval. We matched 30 participants with prolonged QTc interval (cases) with 30 participants with normal QTc interval (controls). Cases and controls were similar in several sociodemographic and clinical characteristics but different regarding the baseline body mass index (BMI), baseline weight, and HIV infection. Increasing BMI (adjusted OR 1.29, 95% CI 1.02-1.63) and HIV infection (adjusted OR 0.27, 95% CI 0.08-0.96) were associated with the cases compared with the controls.
We found a relatively high prevalence of QTc interval prolongation among people with DR-TB on a bedaquiline-containing regimen compared with the prevalence in healthy individuals, with a higher likelihood in those with increasing BMI and a lower likelihood in those with HIV. We recommend routine anthropometric measurements to identify individuals with DR-TB at a high risk for QTc interval prolongation. In addition, tuberculosis/HIV treatment guidelines for people with DR-TB on bedaquiline-containing regimens should include risk assessment for prolonged QTc intervals.
接受含贝达喹啉方案治疗的耐多药结核病（DR-TB）患者存在校正QT（QTc）间期延长的风险，但在资源匮乏国家，这一问题尚未得到充分研究。我们确定了乌干达三家转诊医院中接受含贝达喹啉方案治疗的DR-TB患者QTc间期延长的程度及危险因素。
利用回顾性收集的数据，我们设计了一项匹配病例对照研究，病例为QTc间期延长的参与者，对照为QTc间期正常的参与者，比例为1:1。QTc间期延长定义为心电图中QTc间期较基线增加60毫秒或男性和女性随访期间≥500毫秒。使用多变量条件回归分析在5%显著性水平下确定与病例相比与对照相关的因素，以比值比（OR）和95%置信区间（CI）报告。
153名参与者中，39名（25.5%）QTc间期延长。我们将30名QTc间期延长的参与者（病例）与30名QTc间期正常的参与者（对照）进行匹配。病例和对照在一些社会人口学和临床特征方面相似，但在基线体重指数（BMI）、基线体重和HIV感染方面不同。与对照相比，BMI增加（校正OR 1.29，95%CI 1.02-1.63）和HIV感染（校正OR 0.27，95%CI 0.08-0.96）与病例相关。
我们发现，与健康个体相比，接受含贝达喹啉方案治疗的DR-TB患者中QTc间期延长的患病率相对较高，BMI增加者的可能性更高，HIV感染者的可能性更低。我们建议进行常规人体测量，以识别QTc间期延长风险较高的DR-TB患者。此外，针对接受含贝达喹啉方案治疗的DR-TB患者的结核病/HIV治疗指南应包括QTc间期延长的风险评估。
