Dr Zhao presented her findings on the safety and effectiveness of bedaquiline treatment in patients with MDR-TB at the AIDS 2018 Conference in Amsterdam in July.
Injectable TB treatments are often poorly tolerated and result in substantial toxicity in patients with MDR-TB. Bedaquiline is commonly used in practice as a substitute when injectables are discontinued due to intolerance, but the efficacy and safety of this strategy, particularly amongst patients with HIV, had not been studied. Dr Zhao addressed this question with a retrospective cohort study conducted in the Western Cape.
She identified 162 adults with MDR-TB who received bedaquiline as a substitute treatment and compared their 12-month treatment outcomes to a matched group of 168 controls who received continuous injectable treatment.
Significantly fewer patients experienced a negative outcome in the bedaquiline group. More patients in the bedaquiline group achieved sustained culture conversion and fewer reverted to a positive sputum culture after initial conversion. There was no difference in the number of deaths at 12 and 18 months after treatment initiation, providing additional evidence that bedaquiline is safe and effective in programmatic settings with a high burden of HIV co-infection.
Dr Zhao is a registrar in UCT’s Department of Medicine where she is undertaking her Master of Medicine (MMed) study titled “Improved treatment outcomes with bedaquiline when substituted for second-line injectable agents in multidrug resistant tuberculosis”. She is supervised by Dr Sean Wasserman (CIDRI-Africa Clinical Research Platform Academic) and Professor Graeme Meintjes (CIDRI-Africa Principal Investigator and Clinical Research Platform Lead). A manuscript reporting the study findings has been submitted for publication*.
We congratulate Dr Zhao on conducting a high-quality study for her MMed and this international recognition of the importance of her study.
Citation: Zhao Y, Manning K, Stewart A, Fox T, Tiffin N, Boulle A, Mudaly V, Kock Y, Meintjes G, Wasserman S. Clinical outcomes with bedaquiline use when substituted for second-line injectable agents in multidrug resistant tuberculosis: a retrospective cohort study. In: AIDS2018. Amsterdam; 2018.
*Update: Dr Zhao's manuscript was published in Clinical Infectious Diseases on the 24th of August 2018. Zhao Y, Fox T, Manning K, Stewart A, Tiffin N, Khomo N, Leslie J, Boulle A, Mudaly V, Kock Y, Meintjes G, Wasserman S. Improved treatment outcomes with bedaquiline when substituted for second-line injectable agents in multidrug resistant tuberculosis: a retrospective cohort study. Clinical Infectious Diseases. (2018) :ciy727.