Main Organiser

Julius Centre University of Malaya

Co-organiser

Department of Social and Preventive Medicine, Faculty of Medicine, University of Malay

Supported by

University of Malaya

DETERMINANTS OF UNSUCCESSFUL TUBERCULOSIS TREATMENT OUTCOMES IN HIV-INFECTED PATIENTS IN KLANG VALLEY, MALAYSIA

Author

Ismawati Ismail, Awang Bulgiba

Institution

Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya 50603 Kuala Lumpur, Malaysia

Abstract

Objectives: To examine factors associated with unsuccessful tuberculosis treatment in HIV- infected tuberculosis patients.

Methods: Medical records at the time of TB diagnosis and subsequent follow-up of all registered tuberculosis patients with HIV co- infection at TB clinics in Institute of Respiratory Medicine, Kuala Lumpur and three general hospitals in Selangor between January 2010 and September 2010 were reviewed to get socio- demographic and clinical data. Their medical records were reviewed again nine months after their initial diagnosis to determine the treatment outcome. Multivariate analysis was conducted to identify risk factors for unsuccessful tuberculosis treatment.

Results: Among 215 patients analyzed, successful treatment (cure, completed treatment) was achieved in 48.8% whereas 51.2% of patients had unsuccessful treatment outcome (default, died). After controlling for other factors, it was found that unsuccessful treatment were associated with unemployment (Adj. OR 2.82, 95% CI 1.46-5.46), no antiretroviral therapy (Adj. OR 7.06, 95% CI 3.34- 14.94), and CD4 count < 200 cells/µl (Adj. OR 2.96, 95% CI 1.27-6.90).

Conclusion: HIV-infected tuberculosis patients in Klang Valley had poor treatment outcomes unless they were given concurrent anti-retroviral treatment, were gainfully employed and had good immune status. Implementation of Directly Observed Therapy needs to be reviewed in detail with priority given to these most at risk patients to improve outcomes and survival.