Outcome of MDR-TB patients, 1983-1993. Prolonged survival with appropriate therapy.
We analyzed the clinical and laboratory findings and outcome of 173 patients hospitalized at our institution from 1983 to 1994 with multidrug-resistant tuberculosis (MDR-TB) and evaluated outcome. The 173 patients (mean age 40 +/- 1 yr) were predominantly male (92%), African American or Hispanic (80%), and mostly undomiciled. Over half (52%) were known to be HIV-infected. HIV-positive MDR-TB patients had significantly more pulmonary and constitutional symptoms, more extrapulmonary disease, and fewer cavitary lesions on chest radiographs. Fifty-five percent of the patients in the cohort have died; mortality was significantly greater for HIV-positive than HIV-negative (72% versus 20%, p < 0.01). The median duration of survival of MDR-TB patients was 22 +/- 1 mo. Overall, extrapulmonary involvement was a risk factor for shorter survival, while a cavitary lesion on initial chest film and institution of appropriate treatment were positive predictors of survival. In HIV+ patients, only appropriate therapy was associated with prolonged survival (median of 14.1 mo). Interestingly, there was a trend toward better outcome in the first half of the decade reviewed. We conclude that although mortality from MDR-TB is high in both HIV-positive and HIV-negative patients, institution of appropriate therapy is the factor most strongly associated with a favorable outcome. Development of new diagnostic and therapeutic strategies for MDR-TB are urgently needed.
Department of Medicine, New York University Medical Center, New York, USA.
M M
MM
Park
A L
AL
Davis
N W
NW
Schluger
H
H
Cohen
W N
WN
Rom
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000401:mortality; D000328:Adult; D002423:Cause of Death; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000401:mortality; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000401:mortality* / Q000628:therapy