PMID- 23894358
OWN - NLM
STAT- MEDLINE
DCOM- 20140303
LR  - 20231106
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 8
IP  - 7
DP  - 2013
TI  - Poor outcomes in a cohort of HIV-infected adolescents undergoing treatment for 
      multidrug-resistant tuberculosis in Mumbai, India.
PG  - e68869
LID - 10.1371/journal.pone.0068869 [doi]
LID - e68869
AB  - BACKGROUND: Little is known about the treatment of multidrug-resistant 
      tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present 
      the intermediate outcomes of HIV-infected adolescents aged 10-19 years receiving 
      second-line anti-TB treatment in a Medecins Sans Frontieres (MSF) project in 
      Mumbai, India. METHODS: A retrospective review of medical records of 11 
      adolescents enrolled between July 2007 and January 2013 was undertaken. Patients 
      were initiated on either empirical or individualized second-line ambulatory 
      anti-TB treatment under direct observation. RESULTS: The median age was 16 (IQR 
      14-18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), 
      two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count 
      at the time of MDR-TB diagnosis was 162.7 cells/microl (IQR: 84.8-250.5). By January 
      2013, eight patients had final and 3 had interim outcomes. Favourable results 
      were seen in four (36.5%) patients: one was cured and three were still on 
      treatment with negative culture results. Seven patients (64%) had poor outcomes: 
      four (36.5%) died and three (27%) defaulted. Three of the patients who died never 
      started on antiretroviral and/or TB treatment and one died 16 days after 
      treatment initiation. Two of the defaulted died soon after default. All patients 
      (100%) on-treatment experienced adverse events (AEs): two required permanent 
      discontinuation of the culprit drug and two were hospitalized due to AEs. No 
      patient required permanent discontinuation of the entire second-line TB or 
      antiretroviral regimens. CONCLUSIONS: Early mortality and mortality after default 
      were the most common reasons for poor outcomes in this study. Early mortality 
      suggests the need for rapid diagnosis and prompt treatment initiation, and 
      adolescents might benefit from active contact-tracing and immediate referral. 
      Default occurred at different times, suggesting the need for continuous, 
      intensified and individualized psychosocial support for co-infected adolescents. 
      Operational research among co-infected adolescents will be especially important 
      in designing effective interventions for this vulnerable group.
FAU - Isaakidis, Petros
AU  - Isaakidis P
AD  - Medecins Sans Frontieres, Mumbai, India. msfocb-asia-epidemio@brussels.msf.org
FAU - Paryani, Roma
AU  - Paryani R
FAU - Khan, Samsuddin
AU  - Khan S
FAU - Mansoor, Homa
AU  - Mansoor H
FAU - Manglani, Mamta
AU  - Manglani M
FAU - Valiyakath, Asmaa
AU  - Valiyakath A
FAU - Saranchuk, Peter
AU  - Saranchuk P
FAU - Furin, Jennifer
AU  - Furin J
LA  - eng
PT  - Journal Article
DEP - 20130719
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Antitubercular Agents)
SB  - IM
MH  - Adolescent
MH  - Antitubercular Agents/adverse effects/*therapeutic use
MH  - CD4 Lymphocyte Count
MH  - Child
MH  - *Coinfection
MH  - Female
MH  - *HIV Infections
MH  - Humans
MH  - India
MH  - Male
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Tuberculosis, Multidrug-Resistant/*drug therapy/mortality
MH  - Young Adult
PMC - PMC3716893
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2013/07/31 06:00
MHDA- 2014/03/04 06:00
PMCR- 2013/07/19
CRDT- 2013/07/30 06:00
PHST- 2013/03/21 00:00 [received]
PHST- 2013/06/01 00:00 [accepted]
PHST- 2013/07/30 06:00 [entrez]
PHST- 2013/07/31 06:00 [pubmed]
PHST- 2014/03/04 06:00 [medline]
PHST- 2013/07/19 00:00 [pmc-release]
AID - PONE-D-13-13259 [pii]
AID - 10.1371/journal.pone.0068869 [doi]
PST - epublish
SO  - PLoS One. 2013 Jul 19;8(7):e68869. doi: 10.1371/journal.pone.0068869. Print 2013.