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Resistance to injectable second-line drugs in TB related to age, HIV status
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CDC researchers have reported that several risk factors, including age and positive HIV status, were associated with acquired resistance to injectable second-line drugs in patients with drug-resistant tuberculosis.
Other factors associated with acquired resistance were multidrug-resistant TB and initial treatment with a second-line drug. MDR-TB at treatment initiation was associated with acquired resistance to fluoroquinolones.
“Little is known about the causes of acquired resistance to second-line drugs during treatment,” the researchers wrote in Clinical Infectious Diseases. “As acquired resistance to second-line TB medications severely compromises treatment options for patients with MDR-TB, understanding the factors that lead to acquired resistance to second-line drugs may help identify patients at risk and measures for prevention.”
The researchers evaluated cases of TB that had initial and final drug susceptibility testing complete. The study included 2,274 patients with initial and final drug susceptibility testing for injectable second-line drugs. Among these, 49 had acquired resistance. There were also 1,141 patients with initial and final drug susceptibility for fluoroquinolones, of which 32 had acquired resistance.
Aged 25 to 44 years (OR=2.7; 95% CI, 1.2-6.3), positive HIV status (OR=2.5; 95% CI, 1.3-4.7), MDR-TB at treatment initiation (OR=5.5; 95% CI, 2.9-10.5) and treatment with any second-line injectable drug (OR=2.4; 95% CI, 1.2-4.7) were associated with acquired resistance to injectable second-line drugs. MDR-TB at treatment initiation (OR=6.5; 95% CI, 2.9-14.6) was associated with acquired resistance to fluoroquinolones.
“Resistance to second-line TB medication severely compromises the treatment regimen options for TB patients, and therefore, the identification of patients at risk and prevention of further resistance is important,” the researchers wrote.
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