title: Does Alcohol consumption during multidrug-resistant tuberculosis treatment affect outcome?. A population-based study in Kerala, India.
abstract: BACKGROUND
  India reports the largest number of multidrug-resistant tuberculosis cases in the world; yet, no longitudinal study has assessed factors related to treatment outcomes under programmatic conditions in the public sector.
  
  
  OBJECTIVE
  To describe demographic, clinical, and risk characteristics associated with treatment outcomes for all patients with multidrug-resistant tuberculosis registered in the Revised National Tuberculosis Control Programme, Kerala State, India from January 1, 2009 to June 30, 2010.
  
  
  METHODS
  Cox regression methods were used to calculate adjusted hazard ratios with 95% confidence intervals (CIs) to assess factors associated with an unsuccessful treatment outcome.
  
  
  RESULTS
  Of 179 patients with multidrug-resistant tuberculosis registered, 112 (63%) had successful treatment outcomes (77 bacteriologically cured, 35 treatment completed) and 67 (37%) had unsuccessful treatment outcomes (30 died, 26 defaulted, 9 failed treatment, 1 stopped treatment because of drug-related adverse events, and 1 developed extensively drug-resistant tuberculosis). The hazard for unsuccessful outcome was significantly higher among patients who consumed alcohol during treatment (adjusted hazard ratio, 4.3; 95% CI, 1.1-17.6) than those who did not. Persons who consumed alcohol during treatment, on average, missed 18 more intensive-phase doses (95% CI, 13-22) than those who did not. Although many patients had diabetes (33%), were ever smokers (39%), or had low body mass index (47%), these factors were not associated with outcome.
  
  
  CONCLUSIONS
  Overall treatment success was greater than global and national averages; however, outcomes among patients consuming alcohol remained poor. Integration of care for multidrug-resistant tuberculosis and alcoholism should be considered to improve treatment adherence and outcomes.
authors.affiliation: 1 Department of Tuberculosis, WHO Country Office for India, New Delhi, India.
authors.forename: Karthickeyan
authors.initials: K
authors.lastname: Duraisamy
authors.forename: Sunilkumar
authors.initials: S
authors.lastname: Mrithyunjayan
authors.forename: Smita
authors.initials: S
authors.lastname: Ghosh
authors.forename: Sreenivas Achuthan
authors.initials: SA
authors.lastname: Nair
authors.forename: Shibu
authors.initials: S
authors.lastname: Balakrishnan
authors.forename: Jayasankar
authors.initials: J
authors.lastname: Subramoniapillai
authors.forename: John E
authors.initials: JE
authors.lastname: Oeltmann
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Moonan
authors.forename: Ajay M V
authors.initials: AM
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011159:Population Surveillance; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents
keywords: India; alcohol; multidrug-resistant tuberculosis; multidrug-resistant tuberculosis treatment outcome; tuberculosis
references.citation: Lancet. 2005 Jan 22-28;365(9456):318-26
references.pmid: 15664227
references.citation: Lymphokine Cytokine Res. 1991 Oct;10(5):413-9
references.pmid: 1662988
references.citation: Int J Tuberc Lung Dis. 2007 Jan;11(1):46-53
references.pmid: 17217129
references.citation: BMC Public Health. 2009 Dec 05;9:450
references.pmid: 19961618
references.citation: PLoS One. 2010 Dec 29;5(12):e15735
references.pmid: 21209951
references.citation: Alcohol Clin Exp Res. 2006 Apr;30(4):720-30
references.pmid: 16573591
references.citation: Am J Respir Crit Care Med. 2010 Aug 1;182(3):426-32
references.pmid: 20413630
references.citation: Tuberculosis (Edinb). 2012 Sep;92(5):397-403
references.pmid: 22789497
references.citation: Lancet Infect Dis. 2013 Aug;13(8):690-7
references.pmid: 23743044
references.citation: Lancet Infect Dis. 2009 Mar;9(3):153-61
references.pmid: 19246019
references.citation: Indian J Med Res. 2008 Jun;127(6):555-63
references.pmid: 18765874
references.citation: Rev Infect Dis. 1989 Mar-Apr;11 Suppl 2:S369-78
references.pmid: 2496453
references.citation: J Leukoc Biol. 1995 Sep;58(3):342-50
references.pmid: 7665990
references.citation: Arch Intern Med. 2009 Jan 26;169(2):189-97
references.pmid: 19171816
references.citation: Addiction. 2009 Mar;104(3):331-2
references.pmid: 19207335
references.citation: Alcohol Clin Exp Res. 1984 Jan-Feb;8(1):73-6
references.pmid: 6324608
references.citation: PLoS One. 2011;6(11):e27752
references.pmid: 22132134
references.citation: Addiction. 2013 Aug;108(8):1387-96
references.pmid: 23490304
references.citation: Clin Respir J. 2014 Jan;8(1):11-23
references.pmid: 23875862
references.citation: Indian J Med Res. 2012 May;135(5):690-4
references.pmid: 22771603
references.citation: Emerg Infect Dis. 2014 May;20(5):812-21
references.pmid: 24751166
references.citation: PLoS Med. 2006 Jul;3(7):e241
references.pmid: 16796403
references.citation: Am J Respir Crit Care Med. 2010 Jul 1;182(1):113-9
references.pmid: 20224066
references.citation: PLoS One. 2013 Jul 29;8(7):e70064
references.pmid: 23922904
references.citation: J Public Health Manag Pract. 2005 Jul-Aug;11(4):361-8
references.pmid: 15958938
references.citation: PLoS One. 2009 Sep 09;4(9):e6914
references.pmid: 19742330
references.citation: Addiction. 2010 May;105(5):817-43
references.pmid: 20331573
references.citation: Clin Infect Dis. 2012 Feb 15;54(4):579-81
references.pmid: 22190562
references.citation: Natl Med J India. 2006 Mar-Apr;19(2):94-9
references.pmid: 16756199
references.citation: Alcohol Clin Exp Res. 2010 Feb;34(2):317-30
references.pmid: 19930235