Article Text

Survival of drug resistant tuberculosis patients in Lithuania: retrospective national cohort study
  1. Yanina Balabanova1,2,
  2. Birute Radiulyte3,
  3. Edita Davidaviciene3,
  4. Richard Hooper1,
  5. Olga Ignatyeva2,
  6. Vladyslav Nikolayevskyy1,
  7. Francis A Drobniewski1
  1. 1Blizard Institute, Queen Mary University of London, London, UK
  2. 2Samara Oblast Tuberculosis Dispensary, Samara, Russia
  3. 3National Tuberculosis and Infectious Diseases University Hospital, Vilnius, Lithuania
  1. Correspondence to Dr Yanina Balabanova; y.balabanova{at}qmul.ac.uk

Abstract

Objective To establish risk factors influencing survival of patients with multidrug-resistant and extensively drug-resistant tuberculosis (MDR/XDRTB).

Design All MDR/XDRTB cases (n=1809) reported from 2002 to 2008 in Lithuania with a known outcome were included in the survival analysis.

Results Median survival for MDRTB and XDRTB patients was 4.1 (95% CI 3.7 to 4.4) and 2.9 (95% CI 2.2 to 3.9) years. In a multivariable analysis adjusting for other patient characteristics, the difference in survival between MDRTB and XDRTB patients was not significant (HR=1.29 (0.91 to 1.81)). Older age (HR=4.80 (3.16 to 7.29)) for 60+ vs <30 years, rural living (HR=1.20 (1.02 to 1.40)), alcohol use (HR=1.49 (1.13 to 1.96)) for alcoholic versus moderate use, unemployment (HR=1.79 (1.31 to 2.46)), lower education levels (HR=1.50 (1.08 to 2.07)) for primary level versus tertiary level, cavitary disease (HR=1.54 (1.29 to 1.83)) and being smear positive at the time of MDR/XDRTB diagnosis (HR=1.47 (1.19 to 1.82)) were associated with poorer survival. HIV positivity significantly affected survival (HR=3.44 (1.92 to 6.19)) for HIV positive versus HIV negative; HR=1.60 (1.28 to 2.01) for HIV not tested versus HIV negative). There was no difference in survival of patients who acquired MDR/XDRTB during treatment compared with patients with primary MDR/XDRTB (HR=1.01 (0.85 to 1.19)). Treatment with a second-line drug improved survival (HR=0.40 (0.34 to 0.47)). In a subgroup with genotyped TB strains, a Beijing family of strains was associated with poorer survival (HR=1.71 (1.19 to 2.47)).

Conclusions Social factors, rural living, HIV infection and Beijing strain family impact on survival. Survival of MDR/XDRTB patients is short. Rapid drug resistance identification, early administration of appropriate treatment and achieving high cure rates, expansion of HIV testing and antiretroviral treatment are necessary for optimal management of MDR/XDRTB.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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Footnotes

  • To cite: Balabanova Y, Radiulyte B, Davidaviciene E, et al. Survival of drug resistant tuberculosis patients in Lithuania: retrospective national cohort study. BMJ Open 2011;1:e000351. doi:10.1136/bmjopen-2011-000351

  • Funding The research leading to these results has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement FP7-223681. The funders had no role in the design or analysis of the study.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Vilnius Regional Committee for Biomedical Research Ethics, Vilnius University and Queen Mary College Research Ethics Committee.

  • Contributors YB, FAD, OI, VN and RH designed and implemented the study; BR and ED assisted with data collection. RH performed the statistical analysis; YB and FAD drafted the paper. All authors contributed to drafts and approved the final draft of the manuscript. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Technical appendix, statistical code and partial dataset (anonymised, without any patients-related identifiers) available from the corresponding author at y.balabanova{at}qmul.ac.uk. Informed consent was not obtained from the study participants as the data present routinely collected surveillance data and the risk of identification is low.

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