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Prevalence, risk factors, and treatment outcomes of isoniazid- and rifampicin-mono-resistant pulmonary tuberculosis in Lima, Peru

(2016) PLOS ONE. 11(4).
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Abstract
Background : Isoniazid and rifampicin are the two most efficacious first-line agents for tuberculosis (TB) treatment. We assessed the prevalence of isoniazid and rifampicin mono-resistance, associated risk factors, and the association of mono-resistance on treatment outcomes. Methods : A prospective, observational cohort study enrolled adults with a first episode of smear-positive pulmonary TB from 34 health facilities in a northern district of Lima, Peru, from March 2010 through December 2011. Participants were interviewed and a sputum sample was cultured on Lowenstein-Jensen (LJ) media. Drug susceptibility testing was performed using the proportion method. Medication regimens were documented for each patient. Our primary outcomes were treatment outcome at the end of treatment. The secondary outcome included recurrent episodes among cured patients within two years after completion of the treatment. Results : Of 1292 patients enrolled, 1039 (80%) were culture-positive. From this subpopulation, isoniazid mono-resistance was present in 85 (8%) patients and rifampicin mono-resistance was present in 24 (2%) patients. In the multivariate logistic regression model, isoniazid mono-resistance was associated with illicit drug use (adjusted odds ratio (aOR) = 2.10; 95% confidence interval (CI): 1.1-4.1), and rifampicin mono-resistance was associated with HIV infection (aOR = 9.43; 95% CI: 1.9-47.8). Isoniazid mono-resistant patients had a higherrisk of poor treatment outcomes including treatment failure (2/85, 2%, p-value<0.01) and death (4/85, 5%, p<0.02). Rifampicin mono-resistant patients had a higher risk of death (2/24,8%, p<0.01). Conclusion : A high prevalence of isoniazid and rifampicin mono-resistance was found among TB patients in our low HIV burden setting which were similar to regions with high HIV burden. Patients with isoniazid and rifampicin mono-resistance had an increased risk of poor treatment outcomes.
Keywords
MONORESISTANT TUBERCULOSIS, DRUG-RESISTANCE, UNITED-STATES

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Chicago
Villegas, Leonela, Larissa Otero Vegas, Timothy R Sterling, Moises A Huaman, Patrick Van Der Stuyft, Eduardo Gotuzzo, and Carlos Seas. 2016. “Prevalence, Risk Factors, and Treatment Outcomes of Isoniazid- and Rifampicin-mono-resistant Pulmonary Tuberculosis in Lima, Peru.” Plos One 11 (4).
APA
Villegas, L., Otero Vegas, L., Sterling, T. R., Huaman, M. A., Van Der Stuyft, P., Gotuzzo, E., & Seas, C. (2016). Prevalence, risk factors, and treatment outcomes of isoniazid- and rifampicin-mono-resistant pulmonary tuberculosis in Lima, Peru. PLOS ONE, 11(4).
Vancouver
1.
Villegas L, Otero Vegas L, Sterling TR, Huaman MA, Van Der Stuyft P, Gotuzzo E, et al. Prevalence, risk factors, and treatment outcomes of isoniazid- and rifampicin-mono-resistant pulmonary tuberculosis in Lima, Peru. PLOS ONE. 2016;11(4).
MLA
Villegas, Leonela et al. “Prevalence, Risk Factors, and Treatment Outcomes of Isoniazid- and Rifampicin-mono-resistant Pulmonary Tuberculosis in Lima, Peru.” PLOS ONE 11.4 (2016): n. pag. Print.
@article{8511004,
  abstract     = {Background : Isoniazid and rifampicin are the two most efficacious first-line agents for tuberculosis (TB) treatment. We assessed the prevalence of isoniazid and rifampicin mono-resistance, associated risk factors, and the association of mono-resistance on treatment outcomes. 
Methods : A prospective, observational cohort study enrolled adults with a first episode of smear-positive pulmonary TB from 34 health facilities in a northern district of Lima, Peru, from March 2010 through December 2011. Participants were interviewed and a sputum sample was cultured on Lowenstein-Jensen (LJ) media. Drug susceptibility testing was performed using the proportion method. Medication regimens were documented for each patient. Our primary outcomes were treatment outcome at the end of treatment. The secondary outcome included recurrent episodes among cured patients within two years after completion of the treatment. 
Results : Of 1292 patients enrolled, 1039 (80%) were culture-positive. From this subpopulation, isoniazid mono-resistance was present in 85 (8%) patients and rifampicin mono-resistance was present in 24 (2%) patients. In the multivariate logistic regression model, isoniazid mono-resistance was associated with illicit drug use (adjusted odds ratio (aOR) = 2.10; 95% confidence interval (CI): 1.1-4.1), and rifampicin mono-resistance was associated with HIV infection (aOR = 9.43; 95% CI: 1.9-47.8). Isoniazid mono-resistant patients had a higherrisk of poor treatment outcomes including treatment failure (2/85, 2%, p-value<0.01) and death (4/85, 5%, p<0.02). Rifampicin mono-resistant patients had a higher risk of death (2/24,8%, p<0.01). 
Conclusion : A high prevalence of isoniazid and rifampicin mono-resistance was found among TB patients in our low HIV burden setting which were similar to regions with high HIV burden. Patients with isoniazid and rifampicin mono-resistance had an increased risk of poor treatment outcomes.},
  articleno    = {e0152933},
  author       = {Villegas, Leonela and Otero Vegas, Larissa and Sterling, Timothy R and Huaman, Moises A and Van Der Stuyft, Patrick and Gotuzzo, Eduardo and Seas, Carlos},
  issn         = {1932-6203},
  journal      = {PLOS ONE},
  keywords     = {MONORESISTANT TUBERCULOSIS,DRUG-RESISTANCE,UNITED-STATES},
  language     = {eng},
  number       = {4},
  pages        = {11},
  title        = {Prevalence, risk factors, and treatment outcomes of isoniazid- and rifampicin-mono-resistant pulmonary tuberculosis in Lima, Peru},
  url          = {http://dx.doi.org/10.1371/journal.pone.0152933},
  volume       = {11},
  year         = {2016},
}

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