Pictured: Lead author Temesgen Akalu and Supervisor, Kefyalew Alene
New research has highlighted the long-term physical health problems faced by people who survive drug-resistant tuberculosis (TB) – a major threat to human health that affects almost half a million people globally every year.
Published in the Lancet journal eClinicalMedicine, the study reviewed the experiences of more than 37,000 patients treated for multidrug-resistant (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in 30 countries within Africa, Europe, South America, North America and Asia.
Drug-resistant tuberculosis occurs when the drugs most commonly used to treat TB are no longer able to kill the bacteria. Instead, patients must undergo longer, more toxic treatment to eliminate the TB. Almost 20 per cent of people started on treatment for MDR-TB die during treatment.
Researchers from The Kids Research Institute Australia and Curtin University in Perth, Western Australia found nearly one in two of the 37,380 surviving patients they reviewed was left with ongoing respiratory problems, while about one in three developed a hearing disability. Other common long-term health issues included musculoskeletal, neurological, liver and kidney problems.
Lead author Temesgen Akalu – a PhD student at The Kids and Curtin University and an Assistant Professor in Epidemiology and Biostatistics within the Institute of Public Health at the University of Gondar in Ethiopia – said hearing, neurological, and renal health issues were common among survivors in high-income countries, while respiratory issues were common in low-income countries.
“We found the risk of developing physical health problems was much higher among patients with XDR-TB than MDR-TB,” Mr Akalu said.
We also found that respiratory problems were more common after the completion of treatment, rather than during treatment.
Mr Akalu said drug-resistant tuberculosis was a major but under-recognised global health challenge, with treatment ‘success’ currently defined by microbiological outcomes (eradication of the TB bacteria) and survival.
“This study shows, however, that the story doesn’t end when the patient is cleared of tuberculosis,” he said.
“We found patients treated for MDR and XDR-TB are at higher risk of long-term sequelae, arising either because of the disease process itself or as a result of side-effects from the second-line drugs needed to treat these patients.”
The most common problems were respiratory issues (43.8% across both the MDR-TB and XDR-TB groups) and hearing disability (almost 30% across both groups). These rates were significantly higher than those experienced in patients who recovered from TB that was able to be treated with the usual drugs (respiratory, 33.1%; hearing disability, 14.5%).
Mr Akalu said a major obstacle to tackling the problem to date had been a lack of understanding of the burden involved for those who survive drug-resistant TB.
“There is currently no routine post-treatment follow-up of these patients, which means there has been very little data available to show how widespread this problem is,” he said.
It is essential to incorporate post-treatment surveillance into the management of drug-resistant tuberculosis, to enable early detection and prevention of follow-on health issues.
“If these issues are left untreated, it could result in an increased risk of permanent disability, premature mortality, ongoing stigma, and poor quality of life among drug-resistant tuberculosis survivors.”
The researchers recommended the development of standard monitoring guidelines, dedicated efforts to increase clinician and patient awareness of potential post-treatment physical health problems, and government strategies to build skills and systems for long-term care for patients.
“Health systems must be supported and strengthened to be able to provide appropriate ongoing care to patients after cessation of TB treatment,” the researchers concluded.