Follow-up of patients with multidrug resistant tuberculosis four years after standardized first-line drug treatment.
BACKGROUND
In 2004, an anti-tuberculosis (TB) drug resistance survey in Heilongjiang province, China, enrolled 1574 (79%) new and 421 (21%) retreatment patients. Multi-drug resistant (MDR) TB was detected in 7.2% of new and 30.4% of retreatment patients. All received treatment with standardized first-line drug (FLD) regimens.


RESULTS
We report treatment outcomes of the 2004 cohort, and long-term outcomes as assessed in the second half of 2008. The reported cure rate for MDR-TB patients was 83% (94/113) among new and 66% (85/128) among retreatment patients (P<0.001). Ten of the 241 MDR-TB patients died during treatment. Of the remaining 231, 129 (56%) could be traced in 2008. The overall recurrence rates among new and retreatment cases were 46% and 66%, respectively (P = 0.03). The overall death rates among new and retreatment cases were 25% and 46%, respectively (P = 0.02). Forty percent of the traced new cases and 24% of the retreatment cases were alive and without recurrent TB (P = 0.01). Of the 16 patients who failed or defaulted from treatment in 2004, only two patients were not re-diagnosed with TB by 2008. Of the 111 (86%) patients with an initial successful treatment outcome 63 (57%) had developed recurrent TB, 40 (36%) had died, 27 (24%) of them died of TB. The follow-up period of four years precluded follow-up of all patients. In a highly conservative sensitivity analysis in which we assumed that all non-included patients were alive and did not have recurrent TB, the recurrence and death rate were 33% and 21%.


CONCLUSIONS
Documentation of cure based on conventional smear microscopy was a poor predictor of long term outcomes. MDR-TB patients in Heilongjiang province in China had high recurrence and death rates four years after treatment with standardized FLD regimens, reinforcing the need for early diagnosis and treatment of MDR-TB, including assessment of treatment outcomes with more sensitive laboratory methods.
National Center for Tuberculosis Control and Prevention, China Center for Disease Control and Prevention (China CDC), Beijing, China.
Guang Xue
GX
He
Yan Guang
YG
Xie
Li Xia
LX
Wang
Martien W
MW
Borgdorff
Marieke J
MJ
van der Werf
Ji Huan
JH
Fan
Xing Lu
XL
Yan
Fa Bin
FB
Li
Xue Zhi
XZ
Zhang
Yan Lin
YL
Zhao
Susan
S
van den Hof
D000995:Antitubercular Agents / Q000627:therapeutic use*; D002681:China; D005500:Follow-Up Studies; D006801:Humans; D012008:Recurrence; D012015:Reference Standards; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality
D000995:Antitubercular Agents