Dados do Trabalho

Título

Isoniazid monoresistance and anti-tuberculosis treatment outcome in persons with pulmonary tuberculosis in Brazil

Introdução

The high burden of drug-resistant tuberculosis (DR-TB) is a problem in achieving the goals of the End of TB Strategy by 2035, proposed by the World Health Organization (WHO). In 2020, there were 1.4 million incident cases of isoniazid resistance worldwide, of which 1.1 million were isoniazid monoresistant (Hr). However, there are few data published in the literature among patients with Hr-TB in high-burden countries, and whether Hr affects anti-TB treatment (ATT) outcomes remains unknown.

Objetivo (s)

The aim of this study was to investigate the impact of Hr on ATT outcomes in individuals with pulmonary TB in Brazil.

Material e Métodos

We collected baseline clinical and demographic characteristics, as well as ATT outcomes in persons with pulmonary TB (PWPTB) enrolled in the RePORT-Brazil cohort between June 2015-June 2019 (follow-up through June 2021) in three Brazilian sites; and among PTB cases reported to the National Notifiable Disease Information System (SINAN) in the same period and inclusion criteria. In both cohorts, patients were grouped and compared according to drug-susceptibility testing (DST) results. Only those with Hr or isoniazid-sensitive results remained in the analysis. Binomial logistic regression models were employed to assess whether Hr was independently associated with unfavorable ATT outcomes: death, failure, or recurrence, compared to cure.

Resultados e Conclusão

Among 1,020 PWPTB enrolled in RePORT-Brazil and of 60,804 TB cases identified in SINAN, 689 (67.5%) and 21,197 (34.9%) cases were included in the study, respectively. In RePORT-Brazil, the frequency of unfavorable ATT outcome was not significantly different between groups with or without Hr (20.7% vs 11.9%, respectively; p=0.23). In SINAN, the frequency of unfavorable outcomes was significantly higher in those with Hr in contrast to patients with isoniazid-sensitive TB (9.1% vs 3.05%, p<0.001). Using a binomial logistic regression model to adjust for potential confounders, Hr was associated with unfavorable outcomes (OR: 3.34 [95%CI: 2.06-5.40], p<0.001) in SINAN cohort independently of other clinical characteristics. In conclusion, Hr detected prior to ATT was predictive of unfavorable outcomes. Our data reinforce the need for high TB burden countries to prioritize DST and detect Hr early in the course of ATT. Effective treatment regimens for TB that is Hr are needed to improve outcomes.

Palavras-chave

tuberculosis, isoniazid resistance, treatment outcomes

Agradecimentos

The authors thank the study participants and the teams of platforms of RePORT-Brazil