Clinical Ophthalmology (Dec 2021)
Treatment Outcome of Tubercular Uveitis in a High TB and HIV Setting: A Prospective Cohort Study
Abstract
Hassan Dawood Alli,1 Naseer Ally,1 Ismail Mayet,1 Lavania Joseph,2 Shaheed Omar,2,3 Shabir Madhi4 1Department of Neurosciences, Division of Ophthalmology, St John Eye Hospital, Faculty of Health Sciences, University of the Witwatersrand, Soweto, Gauteng, South Africa; 2Centre for Tuberculosis, National TB Reference Laboratory, WHO TB Supranational Laboratory Network, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; 3Department of Molecular Medicine & Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; 4Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (VIDA), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaCorrespondence: Hassan Dawood AlliDepartment of Neurosciences, Division of Ophthalmology, St John Eye Hospital, Faculty of Health Sciences, University of the Witwatersrand, 26 Chris Hani Road, Diepkloof, Soweto, 1862, Gauteng, South AfricaTel +27833078152Email [email protected]: To determine the time to resolution of inflammation in tubercular uveitis (TBU) cases on standard anti-tubercular treatment. Sub-analysis of time to resolution according to HIV status was also performed.Patients and Methods: A prospective cohort study of presumed idiopathic uveitis cases > 18 years underwent the tuberculin skin test, QuantiFERON-TB Gold test, and ocular tuberculosis (TB) polymerase chain reaction test. Adult TBU cases were treated with standard anti-tubercular therapy (and corticosteroids) for 9 months. Cases were followed-up for resolution of inflammation at 1.5, 3, 6, 9, 12 and 15 months post-diagnosis. Outcome measure was resolution of inflammation on ≤ 10 mg oral prednisone per day.Results: Seventy-nine presumed idiopathic uveitis cases were enrolled in the study, 49 (62%) were diagnosed with TBU. The mean (SD) age of TBU cases at diagnosis was 41.8 (13.4) years. Using a multilevel mixed effects model, resolution was achieved at 6 months in the TBU cases (OR = 1.21; 95% CI, 1.03– 1.41; P = 0.017). Using generalized estimating equations, resolution was also achieved at 6 months in the TBU cases (OR = 1.21; 95% CI, 1.05– 1.39; P = 0.008). The HIV-positive cases (OR = 1.62; 95% CI, 1.13– 2.31; P = 0.008) and the HIV-negative cases (OR = 1.25; 95% CI, 1.06– 1.48; P = 0.009) achieved resolution at 9 months.Conclusion: Resolution of inflammation in TBU cases on anti-tubercular treatment with corticosteroids was achieved at 6 months and maintained throughout the study. Our study suggests a minimum of 6 months treatment is required for significant resolution. Resolution of inflammation in HIV-positive and HIV-negative TBU cases needs to be further explored.Keywords: Mycobacterium tuberculosis, anti-tubercular treatment, inflammation, HIV, resolution
