Treatment Outcomes and Predictive Factors for Multidrug-Resistant TB and HIV Coinfection in Rio De Janeiro State, Brazil

Background: This study aims to identify and compare factors associated with the unfavorable treatment of MDR-TB patients with HIV coinfection in the State of Rio de Janeiro (RJ), Brazil.Methods: A retrospective cohort study with data from TB-MDR patients notified between 2000 and 2016 in RJ. Clinical and epidemiological characteristics and treatment outcomes of patients with HIV positive, negative, and unknown were compared. Bivariate and multivariate Cox hazard regression analysis was conducted to identify factors associated with unfavorable treatment results in patients MDR-TB / HIV positive. Results: Of 2,269 cases, 1,999 (88.1%) had a negative result for HIV, 156 (6.9%) positive and 114 (5.0%) unknown. The proportion of unfavourable outcomes was 43.7% among HIV negative, 52.6% among HIV positive and 43.9% among HIV unknown. Regarding MDR-TB / HIV positive cases, the unfavorable outcomes more prevalent were loss to follow up (24.4%) and death (23.1%). Previous MDR-TB treatment was associated with unsuccess and death. Illicit drugs use was a risk factor for unsuccess and loss to follow up. The six-month culture conversion was a protective factor for unsuccess and death. Administration of antiretroviral therapy was a protective factor for unsuccess, death and failure. The risk of XDR-TB cases for failure was six times higher than that of MDR-TB patients. All XDR-TB / HIV positive cases had unfavorable outcomes.Conclusions: Early identification and immediate initiation of appropriate treatment are key to reducing unfavorable outcomes among MDR-TB / HIV positive. The high proportions of loss to follow-up and death may reflect difficulties in monitoring treatment, due to poor integration between the TB and HIV programs. In addition, none of XDR-TB / HIV positive patient had therapeutic success, highlighting the urgency to incorporate new drugs for the treatment of multidrug-resistant TB by Brazil's Ministry of Health.