C2-1982. Characteristics and Treatment Outcomes of Isoniazid-Monoresistant Tuberculosis (TB) Patients in New York City (NYC), 1995-2005
Session: Poster Session: Resistance in Mycobacteria
Monday, October 27, 2008: 12:00 AM
Room: Hall C
Background: TB therapy without isoniazid (INH) necessitates using medications with greater side effects, increased cost and lower efficacy. Treatment outcomes of INH-monoresistant (INHr) patients are not well described. Methods: Culture-confirmed NYC patients with primary INHr TB or drug-susceptible TB, diagnosed from 1995-2005 were reviewed. Demographic and clinical data were abstracted from the NYC TB registry. Results: There were 12,419 TB patients with drug susceptibility results; 1,361 (11%) isolates were INH resistant±other drugs, 582 (5%) were INHr, and 9,767 (79%) were drug-susceptible. INHr TB cases did not decline over the study period (ptrend=0.05). The median age of INHr patients was 40 vs. 42 years for patients with drug-susceptible isolates (p<0.001); 64% of INHr patients were male. Patients with INHr were more likely to be non-US-born (OR=2.0; 95%CI, 1.6-2.4) and Asian (OR=1.8; 95%CI, 1.3-2.5). Non-US born patients with INHr increased over the study period, from 60% to 87% (ptrend<0.001). INHr patients were more likely to be from Asia (OR=2.3;95%CI,1.8-2.8), Africa (OR=2.0;95%CI,1.3-2.9), and Latin America/Caribbean (OR=1.8;95%CI,1.4-2.2) than patients with drug-susceptible isolates. The median treatment length for INHr patients was 10 vs. 8 months for those with drug-susceptible isolates (p<0.001). INHr patients took >1 year to complete treatment (OR=1.6;95%CI,1.3-2.1). Among INHr patients, 82% completed treatment, 9% died, 4% were lost or refused treatment, and 4% transferred. Among drug-susceptible patients, 80% completed treatment, 14% died, 3% were lost or refused treatment and 2% transferred. Conclusions: INHr disproportionately affects non-US-born and Asian patients. Although NYC TB completion rates were high, INHr patients were treated longer than drug-susceptible patients. With increasing TB incidence among non-US born, the proportion of INHr cases may increase.
Felicia Dworkin, MD, NYC DOHMH, Kieran Hartsough, NYC DOHMH, New York, NY, Shama Ahuja, MPH, New York City Department of Health and Mental Hygiene, New York, NY and  K. Hartsough, None.

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