High Rate of Hypothyroidism in Multidrug-Resistant Tuberculosis Patients Co-Infected with HIV in Mumbai, India

Aristomo Andries, Petros Isaakidis, Mrinalini Das, Samsuddin Khan, Roma Paryani, Chitranjan Desai, Alpa Dalal, Homa Mansoor, Reena Verma, Dolorosa Fernandes, Giovanni Sotgiu, Giovanni B. Migliori, Peter Saranchuk

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article numbere78313
JournalPLoS One
Volume8
Issue number10
DOIs
Publication statusPublished - Oct 23 2013

Fingerprint

Ethionamide
Aminosalicylic Acid
Multidrug-Resistant Tuberculosis
hypothyroidism
Thyrotropin
Hypothyroidism
tuberculosis
Stavudine
India
HIV
thyrotropin
Screening
Therapeutics
acids
Point-of-Care Systems
Monitoring
CD4 Lymphocyte Count
cohort studies
signs and symptoms (animals and humans)
Observational Studies

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Andries, A., Isaakidis, P., Das, M., Khan, S., Paryani, R., Desai, C., ... Saranchuk, P. (2013). High Rate of Hypothyroidism in Multidrug-Resistant Tuberculosis Patients Co-Infected with HIV in Mumbai, India. PLoS One, 8(10), [e78313]. https://doi.org/10.1371/journal.pone.0078313

High Rate of Hypothyroidism in Multidrug-Resistant Tuberculosis Patients Co-Infected with HIV in Mumbai, India. / Andries, Aristomo; Isaakidis, Petros; Das, Mrinalini; Khan, Samsuddin; Paryani, Roma; Desai, Chitranjan; Dalal, Alpa; Mansoor, Homa; Verma, Reena; Fernandes, Dolorosa; Sotgiu, Giovanni; Migliori, Giovanni B.; Saranchuk, Peter.

In: PLoS One, Vol. 8, No. 10, e78313, 23.10.2013.

Research output: Contribution to journalArticle

Andries, A, Isaakidis, P, Das, M, Khan, S, Paryani, R, Desai, C, Dalal, A, Mansoor, H, Verma, R, Fernandes, D, Sotgiu, G, Migliori, GB & Saranchuk, P 2013, 'High Rate of Hypothyroidism in Multidrug-Resistant Tuberculosis Patients Co-Infected with HIV in Mumbai, India', PLoS One, vol. 8, no. 10, e78313. https://doi.org/10.1371/journal.pone.0078313
Andries, Aristomo ; Isaakidis, Petros ; Das, Mrinalini ; Khan, Samsuddin ; Paryani, Roma ; Desai, Chitranjan ; Dalal, Alpa ; Mansoor, Homa ; Verma, Reena ; Fernandes, Dolorosa ; Sotgiu, Giovanni ; Migliori, Giovanni B. ; Saranchuk, Peter. / High Rate of Hypothyroidism in Multidrug-Resistant Tuberculosis Patients Co-Infected with HIV in Mumbai, India. In: PLoS One. 2013 ; Vol. 8, No. 10.
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AU - Isaakidis, Petros

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AU - Khan, Samsuddin

AU - Paryani, Roma

AU - Desai, Chitranjan

AU - Dalal, Alpa

AU - Mansoor, Homa

AU - Verma, Reena

AU - Fernandes, Dolorosa

AU - Sotgiu, Giovanni

AU - Migliori, Giovanni B.

AU - Saranchuk, Peter

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N2 - 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.

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