R. Mehdiyev, F. Huseynov, A. Hajiyev, I. Jahangirov, N. Karimova, A. Jafarov, R. Montanari, Z. Hatamova, S. A. Ahkmedova. Main Medical Department, Ministry of Justice, Baku, International Committee of the Red Cross, Azerbaijan Delegation, Baku, Azerbaijan.
Background: MDR-TB represents a significant threat to ТВ control in Azerbaijan. DRS survey results for 2006, demonstrate high levels of MDR-TB among new (15.6%) and previously treated cases (44.9%) in prisons. In April 2007, the Main Medical Department of the Ministry of Justice started the implementation of the DOTS-plus project in prisons.
Objective: To describe the profiles of MDR-TB patients enrolled to the DOTS-Plus project and to evaluate the most common side effects observed during treatment.
Methodology: While in the foreseeable future, MDR-TB treatment remains unavailable in the civilian sector, it is not possible to ensure the follow-up of MDR-TB detainees after release. Because of this constraint,
Characteristics of MDR-TB patients/ detainees enrolled in treatment in 2007 and common side effects observed |
Patients
n (%)
|
Use of first and/or second line anti-tuberculosis drugs | |
Only first line
|
10 (38.5)
|
First and second line | 16 (61.5) |
Frequency of Category II treatment in the past | |
1 |
9 (33.3)
|
2 | 13 (48.1) |
3 | 5 (18.5) |
Frequency of treatment interruptions in the past | |
0—Never
|
16 (59.3)
|
1—Once | 10 (37) |
2—Twice | 1 (3.7) |
Bacteriological status | |
SS+/CC+
|
27 (100)
|
SS-/CC+ | 0(0) |
X-ray findings | |
Cavitary + infiltrate
|
21 (77.7)
|
Infiltrate | 6 (22.3) |
BMI | |
<18.5
|
13 (48.1)
|
s*18.5 | 14 (51.9) |
Hepatitis С | |
Yes
|
13 (48.1)
|
No
|
10 (37.0) |
Not done | 4 (14.9) |
Hepatitis В | |
Yes
|
0(0)
|
No | 27 (100) |
HIV status | |
Positive
|
1 (3.7)
|
Negative | 26 (96.3) |
DST profile on enrolment in treatment | |
SHR
|
4 (14.8) |
SHZ | 1 (3.7) |
SHRE | 6 (22.2) |
SHREZ | 9(33.3) |
SHREPto | 1 (3.7) |
SHREZPto | 4 (14.8) |
SHROfx | 1 (3.7) |
Common side-effects of second-line ТВ drugs | |
Vomiting
|
8 (29.6)
|
Diarrhoea | 7 (25.9) |
Nausea | 20 (74) |
Headache | 7 (25.9) |
Dizziness | 1 (3.7) |
Peripheral neuropathy | 7 (25.9) |
Psychotic changes | 4 (14.8) |
Depression | 9 (33.3) |
Arthralgia | 7 (25.9) |
Allergic reactions | 2 (7.4) |
Hypokalaemia | 3(11.1) |
SS = sputm smear; CC = culture; BMI = body mass index; DST = drug susceptibility testing; S = streptomycin; H = isoniazid; R rifampicin; Z = pyrazinamide; E = ethambutol; Pto — prothionamide; Ofx = ofloxacin. |
only patients/detainees, who can be fully treated prior to release (i.e. for at least two years) are enrolled into the prison DOTS-Plus pilot program. All patients on treatment are screened regularly for common adverse effects of 2nd line-anti-TB drugs.
Results: Up to 12 June 2007, 27 patients have been enrolled on MDR-TB treatment. Treatment regimens for detainees consist of at least five drugs with either certain, or almost certain, effectiveness. The Table details profiles of patients integrated into treatment and the most common side effects observed during the reported period.
Conclusion: Since 2004, when the first MDR cases have been isolated in the special MDR ward of the penitentiary system, an MDR "waiting list" has been kept. In spite of releases this list has been lengthening and with time, resulting in case studies with increasing co-morbidities. In particular, detainees with advanced stage of ТВ disease have been monitored for co-infections and ТВ long-term multi-organ adverse effects on liver, kidney functionalities and metabolic disorders. Some of these patients are now enrolled in MDR-TB treatment for the first time. The three most common side effects observed were nausea 20 (74%), depression 9 (33.3%) and vomiting 8 (29.6%).