High rate of hypothyroidism in multidrug-resistant tuberculosis patients co-infected with HIV in Mumbai, India
Open accessAbstract
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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Of 69 HIV-infected MDR-TB patients under anti-TB and antiretroviral therapies, 37 (54%) had primary hypothyroidism; co-administration of para-aminosalicylic acid and ethionamide doubled the risk of hypothyroidism (RR = 1.93).
“Of 69 HIV-infected MDR-TB patients under anti-TB and antiretroviral therapies, 37 (54%) had PH (51). Co-administration of PAS and ethionamide doubled the risk of hypothyroidism (RR = 1.93) (51).”
From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [51]
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- Authors
- Andries, A., Isaakidis, P., Das, M., Khan, S., Paryani, R., Desai, C., Dalal, A., Mansoor, H., Verma, R., Fernandes, D., Sotgiu, G., Migliori, G. B., & Saranchuk, P.
- Affiliations
- Guru Teg Bahadur Hospital (IN)
- University of Sassari (IT)
- World Health Organization (CH)
- Médecins Sans Frontières (ZA)
- Corresponding author
- Isaakidis, Petros
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-10-23
- Volume
- 8
- Issue
- 10
- Pages
- e78313
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3806815
- OpenAlex
- W2087608098
- Cited by
- 27
- References
- 33
- Citations by year
- 2024: 1 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 5 · 2018: 3 · 2017: 2 · 2016: 3 · 2015: 3 · 2014: 2
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UnissResearch (Università degli Studi di Sassari) (submittedVersion)
- UnissResearch (Università degli Studi di Sassari) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Medecins Sans Frontieres Field Research (Medecins Sans Frontieres) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Keywords
- hypothyroidism, multidrug-resistant tuberculosis, HIV/TB coinfection, adverse drug reactions, p-aminosalicylic acid, ethionamide, stavudine, antiretroviral therapy, thyroid-stimulating hormone, TSH screening, medication adherence, antituberculosis drug toxicity
- MeSH terms
- Adult, Ethionamide, Female, Humans, Hypothyroidism, India, Male, Aminosalicylic Acid, Prospective Studies, Risk Factors, Thyrotropin, Cohort Studies, HIV Infections, Incidence, Multivariate Analysis, Tuberculosis, Multidrug-Resistant, Stavudine, Coinfection
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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