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High rate of hypothyroidism in multidrug-resistant tuberculosis patients Co-infected with HIV in Mumbai, India

Andries, Aristomo and Isaakidis, Petros and Das, Mrinalini and Khan, Samsuddin and Paryani, Roma and Desai, Chitranjan and Dalal, Alpa and Mansoor, Homa and Verma, Reena and Fernandes, Dolorosa and Sotgiu, Giovanni and Migliori, Giovanni Battista and Saranchuk, Peter (2013) High rate of hypothyroidism in multidrug-resistant tuberculosis patients Co-infected with HIV in Mumbai, India. PLoS One, Vol. 8 (10), e78313. eISSN 1932-6203. Article.

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DOI: 10.1371/journal.pone.0078313


Background: Adverse events (AEs) among HIV-infected patients with multidrug-resistant tuberculosis (MDR-TB) receiving anti-TB and antiretroviral treatments (ART) are under-researched and underreported. Hypothyroidism is a common AE associated with ethionamide, p-aminosalicylic acid (PAS), and stavudine. The aim of this study was to determine the frequency of and risk factors associated with hypothyroidism in HIV/MDR-TB co-infected patients.
Methods: This was a prospective, observational cohort study, using routine laboratory data in a Médecins Sans Frontières (MSF) clinic in collaboration with Sewri TB Hospital, Mumbai, India. Hypothyroidism was defined as a thyroid stimulating hormone (TSH) result >10 mIU/L at least once during treatment. Patients having a baseline result and one additional result after 3 months were eligible for enrolment.
Results: Between October 2006 and March 2013, 116 patients were enrolled, 69 of whom were included. The median (IQR) age was 38 years (34-43) and 61% were male. By March 2013, 37/69 (54%) had hypothyroidism after at least 90 days of treatment. Age, gender, CD4 counts and stavudine-based ART were not associated with the occurrence of hypothyroidism in multivariate models. The co-administration of PAS and ethionamide was found to double the risk of hypothyroidism (RR: 1.93, 95% CI: 1.06-3.54).
Discussion: High rate of hypothyroidism was recorded in a Mumbai cohort of MDR-TB/HIV co-infected patients on treatment. This is a treatable and reversible AE, however, it may go undiagnosed in the absence of regular monitoring. Care providers should not wait for clinical symptoms, as this risks compromising treatment adherence. Simple, affordable and reliable point-of-care tools for measuring TSH are needed, especially in high MDR-TB burden countries. Our findings suggest the need for TSH screening at baseline, three months, six months, and every six months thereafter for HIV-infected patients on MDR-TB treatment regimens containing PAS and/or ethionamide, until newer, safer and more efficacious MDR-TB regimens become available.

Item Type:Article
ID Code:9662
Uncontrolled Keywords:Spatial compatibility, joint Simon effect, joint action, social interaction, social cognition, division of labor, referential coding, action co-representation
Subjects:Area 06 - Scienze mediche > MED/01 Statistica medica
Divisions:001 Università di Sassari > 01-a Nuovi Dipartimenti dal 2012 > Scienze Biomediche
Publisher:Public Library of Science
Copyright Holders:© 2013 Andries et al.
Deposited On:05 Mar 2014 10:26

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