Mortality in adults with multidrug-resistant tuberculosis and HIV by antiretroviral therapy and tuberculosis drug use: an individual patient data meta-analysis Menzies RI-MUHC RESP Program

Lifesaving HIV and tuberculosis medications

Dr. Dick Menzies and his research team played an important role in a recent study that found that implementing a combination of antiretroviral therapy (ART) for HIV and newer tuberculosis (TB) medications decreased the risk of death for adults with multidrug-resistant TB.

The findings, which were published in The Lancet, suggest that every effort should be made to quickly bring these life-saving medications to those in need.

Read the article here:

Mortality in adults with multidrug-resistant tuberculosis and HIV by antiretroviral therapy and tuberculosis drug use: an individual patient data meta-analysis.
Bisson GP, Bastos M, Campbell JR, Bang D, Brust JC, Isaakadis P, Lange C, Menzies D, Migliori GB, Pape JW, Palmero D, Baghei P, Tabarsi P, Viiklepp P, Vilbrun S, Walsh J, Marks SM. Lancet. 2020 Aug 8;396(10248):402-411.

For the full news release, read here: McGill Med e-News

Research suggests greater access to specific HIV and tuberculosis medications is needed worldwide.
A specific combination of HIV and TB treatments, difficult to obtain in certain parts of the world, decreased mortality risk for patients with HIV and multidrug-resistant TB

To complete their study, the research team examined the health records of over 10,000 patients with multidrug-resistant tuberculosis in many different countries. In the largest individual patient data meta-analysis study to assess mortality risk of people with both HIV and multidrug-resistant TB, scientists first compared the risk of death for HIV-positive people versus HIV-negative people, then examined how receiving ART and different types of TB drugs altered this risk. Because of the large sample size, associations of specific TB drugs with mortality were evaluated, focusing on the most effective drugs, categorized as “Group A” by the WHO. To accomplish this, data from over 100 different investigators managed at McGill by Dr. Dick Menzies was used. The database, originally compiled some 10 years ago and updated on a near annual basis, has previously been used to inform WHO guidelines and perform other timely analyses for multidrug-resistant TB.

For this latest study, the primary statistical analyses were carried out by McGill postdoctoral fellows Drs. Mayara Bastos and Jonathon Campbell. Ultimately, using data from 52 studies and 37 different countries, the investigators controlled for things like age, the wealth of the region in which the individuals lived, and severity of drug resistance. Researchers found that while patients with HIV infection were at higher risk of death, this risk was reduced substantially when Group A TB drugs and ART were used. As there are various types of Group A TB medications, the odds of survival varied based on which Group A medication or combination was employed. When looking at only those with HIV, the risk of death was reduced by over 80% with use of specific TB drugs, including bedaquiline.

This research lays a foundation to further investigate the success of specific ARTs in conjunction with TB medications. It also allows the medical community to study methods that might bring these treatments to those who have trouble affording them or accessing them where they live.

Source files from the University of Pennsylvania