Date of Award

Summer 8-7-2018

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Matthew J. Magee

Second Advisor

Dr. Richard Rothenberg

Abstract

BACKGROUND

Multidrug-resistant (MDR) tuberculosis (TB) is a public health emergency that causes substantial morbidity and mortality. Treatment of MDR-TB requires 9-24 months of second-line regimens, has poor success rates, and frequently results in harmful side effects. Hepatitis C virus (HCV) co-infection is a common comorbidity among patients with MDR-TB/HIV and contributes to acute and chronic liver conditions, potentially increasing the risk of hepatotoxicity and adverse treatment outcomes. The aim of this study was to estimate the association between HCV co-infection and adverse MDR-TB treatment outcomes among patients with MDR-TB and HIV.

METHODS

We conducted a retrospective cohort study among MDR-TB patients co-infected with HIV receiving clinical care from Médecins Sans Frontières (MSF) in Yangon, Myanmar during 2009-2017. Eligible patients included adults aged ≥18 years who had final MDR-TB treatment outcome and HCV status documented. HCV status was determined by OraQuick® antibody test. Treatment outcome was classified as favorable (cured and treatment completed) or adverse (default, failed, died, not evaluated).

RESULTS

Among patients with MDR-TB and HIV (n=220), the overall treatment success rate was 65% (95%CI 59 – 71%) and 8% (95%CI 5-12%) had HCV. Co-infection with HCV was not significantly associated with adverse treatment outcome in unadjusted (OR 1.33, 95%CI 0.49 – 3.65) or adjusted analyses (aOR 1.43, 95%CI 0.50 – 4.03).

CONCLUSION

Whether patients with HIV/HCV co-infection require altered MDR-TB treatment regimens remains an important gap in knowledge. Additional research is needed to determine the relationship between the extent of hepatotoxicity due to HCV co-infection, interaction with second-line TB medications, and risk of poor MDR-TB treatment outcomes among patients with and without HIV.

Available for download on Friday, July 26, 2019

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