%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Atwine, D.
%A Orikiriza, P.
%A Taremwa, I.
%A Ayebare, A.
%A Logoose, S.
%A Mwanga-Amumpaire, J.
%A Jindani, A.
%A Bonnet, Maryline
%T Predictors of delayed culture conversion among Ugandan patients
%D 2017
%L fdi:010070020
%G ENG
%J BMC Infectious Diseases
%@ 1471-2334
%K Delayed culture conversion ; Efficacy ; HIV-negative TB patients ; Time-to-detection ; Treatment failure
%K OUGANDA
%M ISI:000400435700002
%P art. 299 [8 ]
%R 10.1186/s12879-017-2335-7
%U https://www.documentation.ird.fr/hor/fdi:010070020
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers17-05/010070020.pdf
%V 17
%W Horizon (IRD)
%X Background: Estimates of month-2 culture conversion, a proxy indicator of tuberculosis (TB) treatment efficacy in phase-2 trials can vary by culture-type and geographically with lower rates reported among African sites. The sub-study aimed at comparing TB detection rates of different culture media, within and across rifampicin-based regimens (R10, 15 and 20 mg/Kg) over a 6-month treatment follow-up period, and to establish predictors of month-2 culture non-conversion among HIV-negative TB patients enrolled at RIFATOX trial site in Uganda. Methods: Unlike in other Rifatox Trial sites, it is only in Uganda were Lowenstein-Jensen (LJ) and Mycobacteria growth indicator tube (MGIT) were used throughout 6-months for treatment monitoring. Conversion rates were compared at month-2, 4 and 6 across cultures and treatment-type. Binomial regression analysis performed for predictors of month-2 non-conversion. Results: Of the 100 enrolled patients, 45% had converted based on combined LJ and MGIT by month-2, with no significant differences across treatment arms, p = 0.721. LJ exhibited higher conversion rates than MGIT at month-2 (58.4% vs 56.0%, p = 0.0707) and month-4 (98.9% vs 88.4%, p = 0.0391) respectively, more so within the high-dose rifampicin arms. All patients had converted by month-6. Time-to-TB detection (TTD) on MGIT and social service jobs independently predict month-2 non-conversion. Conclusion: The month-2 culture conversion used in phase 2 clinical trials as surrogate marker of treatment efficacy is influenced by the culture method used for monitoring mycobacterial response to TB treatment. Therefore, multi-centric TB therapeutic trials using early efficacy endpoint should use the same culture method across sites. The Time-to-detection of MTB on MGIT prior to treatment and working in Social service jobs bear an increased risk of culture non-conversion at month-2.
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