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Treatment outcomes for isoniazid-monoresistant tuberculosis in Peru, 2012-2014

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dc.contributor.author Cornejo Garcia, Jose Gabriel
dc.contributor.author Alarcón Guizado, Valentina Antonieta
dc.contributor.author Mendoza Ticona, Alberto
dc.contributor.author Alarcon, Edith
dc.contributor.author Heldal, Einar
dc.contributor.author Moore, David Alexander James
dc.date.accessioned 2019-03-05T15:23:30Z
dc.date.available 2019-03-05T15:23:30Z
dc.date.issued 2018
dc.identifier.uri https://hdl.handle.net/20.500.12866/5896
dc.description.abstract Background: Resistance to isoniazid is the most common form of drug-resistance in tuberculosis. However only a tiny proportion of TB patients in the world have access to isoniazid drug susceptibility testing—the widely implemented Xpert MTB/RIF technology only tests for resistance to rifampicin. Patients with isoniazid mono resistance that is not identified at baseline are treated with a standard regimen that effectively results in rifampicin mono-therapy during the latter four months of the six month treatment course, exposing remaining viable organisms to a single agent and greatly increasing the risk of development of multi drug-resistant TB. Unusually, Peru has pioneered universal pre-treatment drug susceptibility testing with methods that identify isoniazid resistance and has thus identified a large number of individuals requiring tailored therapy. Since 2010, treatment in Peru for isoniazid-resistant tuberculosis without multidrug-resistant tuberculosis (Hr-TB) has been with a standardized nine-month regimen of levofloxacin, rifampicin, ethambutol and pyrazinamide. The objectives of this study were to evaluate the outcomes of treatment for patients with Hr-TB initiating treatment with this regimen between January 2012 and December 2014 and to determine factors affecting these outcomes. Methods: Retrospective cross-sectional study; case data were obtained from the national registry of drug-resistant tuberculosis. Patients diagnosed with isoniazid resistant TB without resistance to rifampicin, pyrazinamide, ethambutol and quinolones as determined by either a rapid drug susceptibility testing (DST) (nitrate reductase test, MODS, Genotype MTBDRplus) or by the proportion method were included. Findings: A total of 947 cases were evaluated (a further 403 without treatment end date were excluded), with treatment success in 77.2% (731 cases), loss to follow-up in 19.7% (186 cases), treatment failure in 1.2% (12 cases), and death in 1.9% (18 cases). Unfavorable outcomes were associated in multivariate analysis with male gender (OR 0.50, 95% CI 0.34–0.72, p<0.05), lack of rapid DST (OR 0.67, 95% CI 0.50–0.91, p = 0.01), additional use of an injectable second-line anti-tuberculous drug (OR 0.46, 95% CI 0.31–0.70, p<0.05), and treatment initiation in 2014 (OR 0.77, 95% CI 0.62–0.94, p = 0.01). Interpretation: The treatment regimen implemented in Peru for isoniazid resistant TB is effective for TB cure and is not improved by addition of an injectable second-line agent. Access to rapid DST and treatment adherence need to be strengthened to increase favorable results. en_US
dc.language.iso eng
dc.publisher Public Library of Science
dc.relation.ispartofseries PLoS ONE
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject adolescent en_US
dc.subject adult en_US
dc.subject aged en_US
dc.subject antibiotic resistance en_US
dc.subject antibiotic sensitivity en_US
dc.subject Article en_US
dc.subject child en_US
dc.subject cohort analysis en_US
dc.subject controlled study en_US
dc.subject cross-sectional study en_US
dc.subject death en_US
dc.subject drug resistant tuberculosis en_US
dc.subject ethambutol en_US
dc.subject female en_US
dc.subject follow up en_US
dc.subject human en_US
dc.subject infant en_US
dc.subject infection risk en_US
dc.subject isoniazid en_US
dc.subject lack of drug effect en_US
dc.subject levofloxacin en_US
dc.subject major clinical study en_US
dc.subject male en_US
dc.subject middle aged en_US
dc.subject monotherapy en_US
dc.subject Peru en_US
dc.subject pyrazinamide en_US
dc.subject retrospective study en_US
dc.subject rifampicin en_US
dc.subject treatment duration en_US
dc.subject treatment outcome en_US
dc.subject tuberculostatic agent en_US
dc.subject young adult en_US
dc.title Treatment outcomes for isoniazid-monoresistant tuberculosis in Peru, 2012-2014 en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1371/journal.pone.0206658
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.01.05
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.07
dc.relation.issn 1932-6203


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