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Survival of drug resistant tuberculosis patients in Lithuania: Retrospective national cohort study

Title: Survival of drug resistant tuberculosis patients in Lithuania: Retrospective national cohort study
Authors: Balabanova, Y
Balabanova, Y
Radiulyte, B
Davidaviciene, E
Hooper, R
Ignatyeva, O
Nikolayevskyy, V
Drobniewski, FA
Item Type: Journal Article
Abstract: Objective: To establish risk factors influencing survival of patients with multidrug-resistant and extensively drug-resistant tuberculosis (MDR/XDRTB). Design: All MDR/XDRTB cases (n=1809) reported from 2002 to 2008 in Lithuania with a known outcome were included in the survival analysis. Results: Median survival for MDRTB and XDRTB patients was 4.1 (95% CI 3.7 to 4.4) and 2.9 (95% CI 2.2 to 3.9) years. In a multivariable analysis adjusting for other patient characteristics, the difference in survival between MDRTB and XDRTB patients was not significant (HR=1.29 (0.91 to 1.81)). Older age (HR=4.80 (3.16 to 7.29)) for 60+ vs <30 years, rural living (HR=1.20 (1.02 to 1.40)), alcohol use (HR=1.49 (1.13 to 1.96)) for alcoholic versus moderate use, unemployment (HR=1.79 (1.31 to 2.46)), lower education levels (HR=1.50 (1.08 to 2.07)) for primary level versus tertiary level, cavitary disease (HR=1.54 (1.29 to 1.83)) and being smear positive at the time of MDR/XDRTB diagnosis (HR=1.47 (1.19 to 1.82)) were associated with poorer survival. HIV positivity significantly affected survival (HR=3.44 (1.92 to 6.19)) for HIV positive versus HIV negative; HR=1.60 (1.28 to 2.01) for HIV not tested versus HIV negative). There was no difference in survival of patients who acquired MDR/XDRTB during treatment compared with patients with primary MDR/XDRTB (HR=1.01 (0.85 to 1.19)). Treatment with a second-line drug improved survival (HR=0.40 (0.34 to 0.47)). In a subgroup with genotyped TB strains, a Beijing family of strains was associated with poorer survival (HR=1.71 (1.19 to 2.47)). Conclusions: Social factors, rural living, HIV infection and Beijing strain family impact on survival. Survival of MDR/XDRTB patients is short. Rapid drug resistance identification, early administration of appropriate treatment and achieving high cure rates, expansion of HIV testing and antiretroviral treatment are necessary for optimal management of MDR/XDRTB.
Issue Date: 1-Dec-2011
Date of Acceptance: 28-Sep-2011
URI: http://hdl.handle.net/10044/1/23740
DOI: https://dx.doi.org/10.1136/bmjopen-2011-000351
ISSN: 2044-6055
Publisher: BMJ Publishing Group: Open Access
Journal / Book Title: BMJ Open
Volume: 1
Issue: 2
Copyright Statement: © 2011, British Medical Journal Publishing Group. This final article is available for use under the terms of the Creative Commons Attribution Non-Commercial 2.0 Licence; see http://bmjopen.bmj.com
Publication Status: Published
Article Number: e000351
Appears in Collections:Department of Medicine
Faculty of Medicine



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