Evidence map›Paper›PMID 35608016›Full record

ArticleHIV medicine2022

High mortality among patients hospitalized for drug-resistant tuberculosis with acquired second-line drug resistance and high HIV prevalence.

Kim Anderson, Elize Pietersen, Bryan E Shepherd, Aihua Bian, Keertan Dheda, Robin Warren, Timothy R Sterling, Yuri F van der Heijden

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in HIV medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
0.9field-weighted citation impact, top 26% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 3 countries.

Kim AndersonCentre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa.ORCID 0000-0002-2453-6219
Elize PietersenCentre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa.
Bryan E ShepherdDepartment of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Aihua BianDepartment of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Keertan DhedaCentre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa.
Robin WarrenDST-NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for TB Research/Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
Timothy R SterlingVanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Yuri F van der HeijdenVanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Vanderbilt University · USUniversity of Cape Town · ZASouth African Medical Research Council · ZA

Funding

Poor Treatment Response and Outcomes in Bedaquiline-Based Treatment Regimens for Drug-Resistant Tuberculosis in South AfricaR01AI158605 · NIAID · VANDERBILT UNIVERSITY MEDICAL CENTER · PI Yuri F. van der Heijden · 2021 to 2026
$3.0M
Fluoroquinolone resistance in patients with multidrug-resistant tuberculosisK08AI106420 · NIAID · VANDERBILT UNIVERSITY MEDICAL CENTER · PI VAN DER HEIJDEN, YURI F. · 2014 to 2018
$848k
Medical Research Council MR/S03563X/1NIAID NIH HHS K08 AI106420NIAID NIH HHS R01 AI158605Wellcome Trust
6 · The paper itself

Abstract

objectivesWe compared mortality between HIV-positive and HIV-negative South African adults with drug-resistant tuberculosis (DR-TB) and high incidence of acquired second-line drug resistance.

methodsWe performed a retrospective review of DR-TB patients with serial second-line TB drug susceptibility tests (2008-2015) who were hospitalized at a specialized TB hospital. We used Kaplan-Meier analysis and Cox models to examine associations with mortality.

resultsOf 245 patients, the median age was 33 years, 54% were male and 40% were HIV-positive, 96% of whom had ever received antiretroviral therapy (ART). At initial drug resistance detection, 99% of patients had resistance to at least rifampicin and isoniazid, and 18% had second-line drug resistance (fluoroquinolones and/or injectable drugs). At later testing, 88% of patients had acquired additional second-line drug resistance. Patient-initiated treatment interruptions (> 2 months) occurred in 47%. Mortality was 79%. Those with HIV had a shorter time to death (p = 0.02; log-rank): median survival time from DR-TB treatment initiation was 2.44 years [95% confidence interval (CI): 2.09-3.15] versus 3.99 years (95% CI: 3.12-4.75) for HIV-negative patients. HIV-positive patients who received ART within 6 months before DR-TB treatment had a higher mortality hazard than HIV-negative patients [adjusted hazard ratio (aHR) ratio = 1.82, 95% CI: 1.21-2.74]. By contrast, HIV-positive patients who did not receive ART within 6 months before DR-TB treatment did not have a significantly higher mortality hazard than HIV-negative patients (aHR = 1.09; 95% CI: 0.72-1.65), although those on ART had lower median CD4 counts than those not on ART (157 vs. 281 cells/μL, respectively; p = 0.02).

conclusionsA very high incidence of acquired second-line drug resistance and high overall mortality were observed, reinforcing the need to reduce the risk of acquired resistance and for more effective treatment.

Indexed as

HIV InfectionsTuberculosis, Multidrug-ResistantAdultAntitubercular AgentsDrug ResistanceFemaleFluoroquinolonesHumansIsoniazidMalePrevalenceRetrospective StudiesRifampinAntitubercular AgentsFluoroquinolonesIsoniazidRifampinacquired resistancedrug-resistant tuberculosisHIVmortality

Identifiers

PMID35608016
PMCPMC9588462
OpenAlexW4282922166

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.