Exciting Results from HIV/TB Study

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Integrated multi - and extensively drug resistant tuberculosis (M(X)DR-TB) and HIV treatment have the potential to improve treatment outcomes, according to a UKZN PhD study conducted by the Deputy Director for the Centre for the AIDS Programme of Research in South Africa (CAPRISA), Dr Nesri Padayatchi.

The study earned Padayatchi a PhD in Public Health Medicine.

The study titled: “Factors Influencing Treatment Outcomes in Multi - and Extensively Drug Resistant Tuberculosis [M(X)DR-TB] patients Co-Infected with HIV in KwaZulu-Natal,  investigated factors which impact on treatment outcomes in M(X)DR-TB patients with HIV co-infection. 

‘I found that early initiation of antiretroviral therapy (ART) in such patients significantly reduced mortality. Xpert MTB/RIF, a new TB diagnostic tool, reduced the duration of  MDR-TB treatment from three months to three weeks and Clofaziminec (a leprosy drug used to treat drug resistant TB)  improved culture conversion even in patients who are HIV infected,’ said Padayatchi.

‘In South Africa control of TB has been hampered by the HIV epidemic and the increased incidence rates of multi-drug resistant tuberculosis (MDR-TB), and extensively drug resistant tuberculosis (XDR-TB),’ she said. 

According to Padayatchi, between 2008 and 2011, South Africa reported the fourth highest number of MDR–TB cases in the world, with  KwaZulu-Natal being the epicentre of both the HIV and M(X)DR- TB epidemics.

‘A subgroup analysis of the SAPiT trial, a randomised controlled trial (RCT) of TB/HIV treatment integration, showed that early initiation of ART in MDR-TB patients reduced mortality by 86% independent of the late initiation of MDR-TB treatment due to delays in laboratory diagnosis of MDR-TB,’ said Padayatchi.  

She said this was the first randomised controlled trial to show that anti-retroviral treatment would improve survival in patients with drug resistant TB sufficiently long enough for them to obtain a diagnosis and treatment.

‘This is the first study to show that Clofazminine can be safely used in patients with HIV.’

This was also a the first study to show that a point of care diagnostic for drug resistant TB whilst shortening the time to diagnosis, has little impact on outcome; ‘Hence we need to change health seeking behaviour and strengthen the health system for new technology to have an impact.

‘It also highlights the plight of infants and children, that without appropriate preventative treatment for them, they will bear the brunt of the dreaded disease of drug resistant TB,’ she said.

Padayatchi plans to dedicate more time to the issue of multi and extremely drug resistant TB, and mobilise and motivate the same passion in others.

‘My motto in life is “when life hands you lemons, make lemonade” and “Depression is a luxury I can’t afford”,’ said Padayatchi.

Padayatchi said her family was very proud of her achievement, ‘They feel inspired - they have always encouraged me through all my pursuits. Together with my spirituality, this is what sustains me.’

 Nombuso Dlamini