%0 Journal Article
%T Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study
%A Edward C. Jones-L車pez equal contributor
%A Irene Ayakaka equal contributor
%A Jonathan Levin
%A Nancy Reilly
%A Francis Mumbowa
%A Scott Dryden-Peterson
%A Grace Nyakoojo
%A Kevin Fennelly
%A Beth Temple
%A Susan Nakubulwa
%A Moses L. Joloba
%A Alphonse Okwera
%A Kathleen D. Eisenach
%A Ruth McNerney
%A Alison M. Elliott
%A Jerrold J. Ellner
%A Peter G. Smith
%A Roy D. Mugerwa
%J PLOS Medicine
%D 2011
%I Public Library of Science (PLoS)
%R 10.1371/journal.pmed.1000427
%X Background Each year, 10%每20% of patients with tuberculosis (TB) in low- and middle-income countries present with previously treated TB and are empirically started on a World Health Organization (WHO)-recommended standardized retreatment regimen. The effectiveness of this retreatment regimen has not been systematically evaluated. Methods and Findings From July 2003 to January 2007, we enrolled smear-positive, pulmonary TB patients into a prospective cohort to study treatment outcomes and mortality during and after treatment with the standardized retreatment regimen. Median time of follow-up was 21 months (interquartile range 12每33 months). A total of 29/148 (20%) HIV-uninfected and 37/140 (26%) HIV-infected patients had an unsuccessful treatment outcome. In a multiple logistic regression analysis to adjust for confounding, factors associated with an unsuccessful treatment outcome were poor adherence (adjusted odds ratio [aOR] associated with missing half or more of scheduled doses 2.39; 95% confidence interval (CI) 1.10每5.22), HIV infection (2.16; 1.01每4.61), age (aOR for 10-year increase 1.59; 1.13每2.25), and duration of TB symptoms (aOR for 1-month increase 1.12; 1.04每1.20). All patients with multidrug-resistant TB had an unsuccessful treatment outcome. HIV-infected individuals were more likely to die than HIV-uninfected individuals (p<0.0001). Multidrug-resistant TB at enrolment was the only common risk factor for death during follow-up for both HIV-infected (adjusted hazard ratio [aHR] 17.9; 6.0每53.4) and HIV-uninfected (14.7; 4.1每52.2) individuals. Other risk factors for death during follow-up among HIV-infected patients were CD4<50 cells/ml and no antiretroviral treatment (aHR 7.4, compared to patients with CD4≡200; 3.0每18.8) and Karnofsky score <70 (2.1; 1.1每4.1); and among HIV-uninfected patients were poor adherence (missing half or more of doses) (3.5; 1.1每10.6) and duration of TB symptoms (aHR for a 1-month increase 1.9; 1.0每3.5). Conclusions The recommended regimen for retreatment TB in Uganda yields an unacceptable proportion of unsuccessful outcomes. There is a need to evaluate new treatment strategies in these patients. Please see later in the article for the Editors' Summary
%U http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000427