Highly successful treatment outcome of multidrug-resistant tuberculosis in the Netherlands, 2000-2009.

SETTING: Resistance to the two key anti-tuberculosis drugs isoniazid and rifampicin is a characteristic of multidrug-resistant tuberculosis (MDR-TB). MDR-TB is a scourge requiring toxic, prolonged treatment and is associated with poor outcomes. The Netherlands is a country with a long-standing, integrated, well-resourced TB service where all patients are offered culture-confirmed diagnosis by a central reference laboratory. OBJECTIVE: To assess the treatment outcomes of MDR-TB patients over a period of 10 years in The Netherlands. DESIGN: Demographic, clinical and microbiological features of all patients with MDR-TB who started treatment in 2000-2009 in the Netherlands were analysed from national registry and patient records. RESULTS: Characteristics of the 113 MDR-TB patients were as follows: male/female ratio 1.57, 96% foreign born, median age 29 years, 96 (85%) pulmonary TB, 56 (50%) smear-positive, 14 (12%) human immunodeficiency virus (HIV) co-infected. Of the 104 (92%) patients who started MDR-TB treatment, 86% had a successful outcome using a median of six active drugs; eight underwent pulmonary surgery. HIV negativity was associated with successful outcome (adjusted OR 2.1, 95%CI 1.1-3.8). CONCLUSION: High success rates for MDR-TB treatment were achieved with close collaboration of all stakeholders, reaching the targets set for drug-susceptible TB. HIV remained an independent risk factor for unsuccessful treatment outcome.

HIV-related mortality among tuberculosis patients in The Netherlands, 1993-2001.

Human immunodeficiency virus (HIV) infection in tuberculosis (TB) patients in The Netherlands during the period 1993-2001 was associated with an increased risk of death (adjusted odds ratio 4.71, P < 0.002). Age and sex-standardised mortality rates among HIV-infected TB patients decreased significantly over time, from 22.9% in 1993-1995 to 11.8% in 1999-2001 (P < 0.001). No such change was observed for HIV-negative patients. The decrease in mortality is likely due to the more widespread use of highly active antiretroviral therapy (HAART).

[HIV-test policy for tuberculosis patients in the Netherlands]. / Hiv-testbeleid bij tuberculosepatiënten in Nederland.

OBJECTIVE: To compare the proportion of tuberculosis patients tested for HIV infection, before and after introduction of highly active antiretroviral therapy (HAART) in the Netherlands, and to analyse predictive factors for performing an HTV-test in this population. DESIGN: Retrospective. METHOD: Whether patients had been tested for HIV, was investigated in random samples consisting of 200 patients, who were registered in the Netherlands Tuberculosis Register (NTR) in the years 1995 and 2001 respectively. RESULTS: The number of patients tested for HIV was 29 out of 84 (16%) in 1995, and 39 out of 190 (21%) in 2001 (not significant). HIV-tests had been carried out most frequently among homeless patients (71%), drug addicts (56%) and alcohol-abusing patients (60%). Significant predictive factors for HIV testing were place of residence (city), localisation of disease (pulmonary tuberculosis in combination with extrapulmonary tuberculosis) and place of origin (sub-Saharan Africa). CONCLUSION: Despite introduction of HAART during this period, in the Netherlands the proportion of tuberculosis patients tested for HIV did not significantly increase between 1995 and 2001. HIV testing was mainly limited to tuberculosis patients from risk groups.

HIV prevalence among tuberculosis patients in The Netherlands, 1993-2001: trends and risk factors.

OBJECTIVES: To describe the prevalence and predictive factors of human immunodeficiency virus (HIV) infection among tuberculosis (TB) patients in The Netherlands during the period 1993-2001. DESIGN: Data were obtained from the national surveillance register of all patients notified with TB (all forms) during the period of the study. In addition, records or discharge notes were checked of a random sample of 200 TB patients notified in 1995 and another 200 in 2001. RESULTS: Of 13 269 patients diagnosed with TB, 542 were HIV-positive (4.1%). Prevalence was 4.1% in 1993-1995, 3.8% in 1996-1998 and 4.4% in 1999-2001. The highest prevalence was observed among drug users (29.2%), homeless patients (20.1%) and patients residing illegally in the country (9.1%). Compared with the period 1993-1995, the relative risk of HIV infection in the periods 1996-1998 and 1999-2001 decreased significantly for drug using patients (P = 0.006), and increased for patients from African countries (P < 0.001). According to patient records, 29/184 (16%) had been tested for HIV in 1995 and 39/190 (21%) in 2001 (P = 0.289); 18 patients tested positive (4.8%). CONCLUSION: Although the prevalence of HIV among TB patients in The Netherlands remained stable between 1993 and 2001, the distribution of risk groups changed over this period.