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Bacteriological conversion in XDR-TB and RR-TB patients with fluoroquinolone resistance treated with and without new and repurposed anti-TB drugs in Azerbaijan prisons

In 2017, the Azerbaijan prisons introduced new and repurposed drugs to the treatment of rifampicin-resistant (RR) tuberculosis (TB): bedaquiline, linezolid and clofazimine. We compared the culture conversion rate in patients with extensively drug-resistant (XDR)- and RR-TB with additional resistance to fluoroquinolones and susceptibility to 2nd-line injectables (SLI) before and after introduction of the new/repurposed drugs in Azerbaijan prisons. The data on eligible patients obtained before and after introduction of the new/repurposed drugs into the treatment regimens were subjected to logistic regression analysis. A total of 29 and 11 patients treated without and with new/repurposed TB drugs were identified with 59% and 100% of culture conversion by the 6th month of treatment, respectively. Increasing number of the effective drugs mainly contributed to the culture conversion (Table).

Hepatitis C virus (HCV)-co-infection and smear- or culture-positivity from the 2nd month of treatment onward significantly decreased the chance for culture conversion by the 6th month. The HCV-co-infection and bacteriological positivity from month 2 onward impair the interim treatment outcome in XDR- and RR-TB patients with resistance to fluoroquinolones and susceptibility to SLI, while increasing the number of effective drugs improves this outcome.