Risk factors and outcome of human immunodeficiency virus-infected patients with sporadic multidrug-resistant tuberculosis in New York City.
METHODS
An 880 bed university teaching hospital in New York City.


OBJECTIVE
To assess risk factors and outcome for sporadic cases of multidrug-resistant tuberculosis (MDR-TB) in persons with human immunodeficiency virus (HIV) infection.


METHODS
In a retrospective cohort analysis, 13 HIV-positive patients with MDR-TB (cases) diagnosed between January 1991 and December 1993 were compared to 31 HIV-infected patients with susceptible or single drug-resistant tuberculosis (controls) diagnosed during the same time period to assess for differences in risk factors and outcome.


RESULTS
Risk factors for MDR-TB included homosexual contact as a risk for HIV transmission, prior antiretroviral therapy and Pneumocystis carinii prophylaxis. Fatality rates were 62% for MDR-TB patients and 26% for controls (P < 0.04). The median survival time was 5.8 months for cases and 9.8 months for controls. Risk factors associated with death included multidrug-resistance and CD4-lymphocyte counts below 200.


CONCLUSIONS
Sporadic MDR-TB infection in HIV-infected patients is associated with increased morbidity and mortality compared to infection with susceptible or single-drug-resistant TB. The median survival for HIV-infected patients with MDR-TB in this study is, however, two to three times longer than previously reported in MDR-TB outbreaks.
Mannheimer
S B
SB
Division of Infectious Diseases and International Medicine, Cornell University Medical College, New York, NY, USA. sbm20@columbia.edu
Sepkowitz
K A
KA
Stoeckle
M
M
Friedman
C R
CR
Hafner
A
A
Riley
L W
LW
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D009519:New York City / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D014505:Urban Population / Q000706:statistics & numerical data*
D000995:Antitubercular Agents