Role of Comorbid Conditions Such as Diabetes, HIV, and Alcohol Abuse in Outcomes of TB Therapy. A Review of Literature Open Access

Tashpulatova, Lolakhon (2017)

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Tuberculosis (TB) is a worldwide infectious disease, which mostly affects lungs. Tuberculosis treatment strategy has been improved and modified continuously during the last 30 years. However, TB problem is still endemic and burden in low-income and developing countries. The major challenges in TB treatment are social-economic conditions and chronic health disorders. Diabetes mellitus (DM) and HIV are leading comorbid conditions for TB. The existing data suggest that, compared with TB cases who do not have diabetes, TBDM patients have a higher risk of poor treatment outcomes and of development of PTB if latently infected with Mycobacterium tuberculosis (MTB). One possible explanation advanced by an investigator is that DM patients may have a slower response rate to TB treatment, or limited absorption of key medications in the TB treatment regimen. Age over 45 years old, male sex, and birthplace in country with high DM rate were described as factors influencing developing DM among TB patients.

HIV infection is the most ‘common' comorbid condition for TB worldwide. HIV is a leading death cause among TB patients. There were an estimated 1.4 million TB deaths in 2015, and an additional 0.4 million deaths resulting from TB disease among people living with HIV. The existing data suggest that HIV patients on ART have better TB treatment outcomes than those who never received ART. HIV and TB co-infection should be treated individually starting with early antiviral therapy and soon adding anti- TB treatment.

Alcohol use disorder (AUD) was also reported as a very frequent social risk factor among TB patients. The existing published observations suggest that alcohol consumption does not significantly influence TB treatment outcomes, but may affect TB screening process and represents an important factor for developing TB disease from latent TB infection.

Table of Contents

Table of Contents

Problem Statement 8 Research Question 9

Problem Statement. Diabetes Mellitus among TB Patient Treatment Outcomes 9

Conclusion 18

Problem Statement. HIV Infections in TB Patients and Treatment Outcomes 19

Conclusion 28

Problem Statement. Alcohol Consumption as a Factor Affecting TB Treatment Outcomes 29

Conclusion 35

References 36 List of Tables

Table 1. One-Year Outcomes of Patients with Newly Diagnosed and Regularly Treated Pulmonary Tuberculosis 10
Table 2. Comparison Between Polymerase Chain Reaction and Ziehl-Neelsen Stain between Polymerase Chain Reaction and Ziehl-Neelsen Stain 15
Table 3. Prevalence of Diabetes among TB Patients in Southern Nigeria 2015 (n = 209) 16
Table 4. Comparison of TB Treatment Success based on HIV Status (N = 529) 25
Table 5. ART Initiation and ATT Outcomes of All Patients with TB-HIV Initiated on ART in the IHC Programme, Mandalay, Myanmar, 2011-2014 28
Table 6. Association of Predictors with Incidence of Antituberculosis-drug-induced Hepatotoxicity in Patients Taking Antituberculosis drugs in Dawro Zone Tercha Hospital and Five Health Centers, Southern Ethiopia, from May 2014 to October 2014 32

List of Figures

Figure 1. Time to Sputum Smear and Culture Conversion (in Days) among 40 DM and 31 non-DM MDR-TB Cases in Mexico 18
Figure 2. Kaplan-Meier Survival Curves 21
Figure 3. Hazard Ratio of Incident Tuberculosis by Duration on ART (with Zero as Reference) among HIV-Infected Individuals in Dar es Salaam, Tanzania 24
Figure 4. Provision of TB Preventive Treatment to People Living with HIV, 2005-2015 26
Figure 5. A Proportion of Excess Alcohol Use in Confirmed TB Cases Aged ≥15 Years Reported to the National TB Surveillance System, United States, 1997-2012 30

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