Relationship between HIV viral suppression and multidrug resistant tuberculosis treatment outcomes

Keri Geiger; Amita Patil; Chakra Budhathoki; Kelly E Dooley; Kelly Lowensen; Norbert Ndjeka; Jacqueline Ngozo; Jason E Farley

doi:10.1371/journal.pgph.0002714

Relationship between HIV viral suppression and multidrug resistant tuberculosis treatment outcomes

PLOS Glob Public Health. 2024 May 6;4(5):e0002714. doi: 10.1371/journal.pgph.0002714. eCollection 2024.

Authors

Keri Geiger^{1

2}, Amita Patil², Chakra Budhathoki¹, Kelly E Dooley³, Kelly Lowensen^{1

2}, Norbert Ndjeka⁴, Jacqueline Ngozo⁵, Jason E Farley^{1

2}

Affiliations

¹ School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America.
² Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, Baltimore, Maryland, United States of America.
³ Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
⁴ National Department of Health, Tuberculosis Control and Management, Pretoria, Gauteng, South Africa.
⁵ KwaZulu-Natal Department of Health, Tuberculosis Programme, Pietermaritzburg, KwaZulu-Natal, South Africa.

Abstract

The impact of HIV viral suppression on multidrug resistant tuberculosis (MDR-TB) treatment outcomes among people with HIV (PWH) has not been clearly established. Using secondary data from a cluster-randomized clinical trial among people with MDR-TB in South Africa, we examined the effects of HIV viral suppression at MDR-TB treatment initiation and throughout treatment on MDR-TB outcomes among PWH using multinomial regression. This analysis included 1479 PWH. Viral suppression (457, 30.9%), detectable viral load (524, 35.4%), or unknown viral load (498, 33.7%) at MDR-TB treatment initiation were almost evenly distributed. Having a detectable HIV viral load at MDR-TB treatment initiation significantly increased risk of death compared to those virally suppressed (relative risk ratio [RRR] 2.12, 95% CI 1.11-4.07). Among 673 (45.5%) PWH with a known viral load at MDR-TB outcome, 194 (28.8%) maintained suppression, 267 (39.7%) became suppressed, 94 (14.0%) became detectable, and 118 (17.5%) were never suppressed. Those who became detectable (RRR 11.50, 95% CI 1.98-66.65) or were never suppressed (RRR 9.28, 95% CI 1.53-56.61) were at significantly increased risk of death (RRR 6.37, 95% CI 1.58-25.70), treatment failure (RRR 4.54, 95% CI 1.35-15.24), and loss to follow-up (RRR 7.00, 95% CI 2.83-17.31; RRR 2.97, 95% CI 1.02-8.61) compared to those who maintained viral suppression. Lack of viral suppression at MDR-TB treatment initiation and failure to achieve or maintain viral suppression during MDR-TB treatment drives differences in MDR-TB outcomes. Early intervention to support access and adherence to antiretroviral therapy among PWH should be prioritized to improve MDR-TB treatment outcomes.

Copyright: © 2024 Geiger et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This work was supported by the National Institute of Allergy and Infectious Disease [NIAID R01AI104488-02; ClinicalTrials.gov Identifier NCT02129244; PI Jason Farley]. KG received funding from the National Center for Advancing Translational Sciences grant number TL1 TR003100. KED is supported by NIAID K24AI150349. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.