Cardiovascular Risk among Patients with Drug-Resistant Tuberculosis and HIV in South Africa

Problem Statement South Africa has the highest incidence of drug resistant-tuberculosis (DR-TB) in sub-Saharan Africa and outcomes are poor. Only 54% of patients successfully complete treatment. The prevalence of HIV co-infection and cardiovascular (CVD) risk factors is also increasing. The purpose of this study was to describe cardiovascular risk in DR-TB patients with and without HIV co-infection and the impact of this risk on 6-month DR-TB negative treatment outcomes among patients co-infected with HIV. Methods This prospective cohort study was nested within an ongoing cluster randomized trial of nurse case management in 10 DR-TB hospitals in Eastern Cape and KwaZulu-Natal, South Africa. The data were collected between November 2014 and July 2016. The prevalence of CVD risk factors and a non-laboratory based risk score were estimated, compared by HIV status, and used to explore the impact on DR-TB negative treatment outcome among 443 HIV co-infected patients. Results Of 900 participants, 53.7% were male, 75.1% were HIV co-infected, and 52.3% had at least one CVD risk factor. Males were more likely to have ever smoked (52.5% vs 7.3%, χ2=207.31, p35 years old, patients with a high or moderate CVD risk score were 4.5 times more likely to have an early negative treatment outcome compared with those with low CVD risk. Conclusions Except for BMI, individual CVD risk factors did not impact early DR-TB outcomes, although an elevated CVD score did increase risk of negative outcome. Providers should screen and treat patients with CVD risk factors according to evidence-based guidelines. Health systems should provide comprehensive, patient-centered care to improve both DR-TB outcomes and CVD related morbidity and mortality in low- and middle-income countries like South Africa