title: Tuberculosis mortality, drug resistance, and infectiousness in patients with and without HIV infection in Peru.
abstract: The effects of HIV co-infection and multi-drug resistant tuberculosis (MDRTB) on tuberculosis prognosis are poorly defined. Therefore, we studied infectiousness and mortality of 287 tuberculosis patients treated with standard, directly observed, short-course therapy in the Peruvian community. During 6-17 months of treatment, 49 (18%) of patients died, of whom 48 (98%) had AIDS and 28 (57%) had MDRTB; 17/31 (55%) of MDRTB-patients with AIDS died within 2 months of diagnosis, before traditional susceptibility testing would have identified their MDRTB. Most non-MDRTB became smear- and culture-negative within 6 weeks of therapy, whereas most MDRTB remained sputum-culture-positive until death or treatment completion. HIV-negative patients with non-MDRTB had good outcomes. However, MDRTB was associated with prolonged infectiousness and HIV co-infection with early mortality, indicating a need for greater access to anti-retroviral therapy. Furthermore, early and rapid tuberculosis drug-susceptibility testing and infection control are required so that MDRTB can be appropriately treated early enough to reduce mortality and transmission.
authors.affiliation: Asociacion Benefica Prisma, Lima, Peru.
authors.forename: Vivian
authors.initials: V
authors.lastname: Kawai
authors.forename: Giselle
authors.initials: G
authors.lastname: Soto
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: Christian T
authors.initials: CT
authors.lastname: Bautista
authors.forename: Luz
authors.initials: L
authors.lastname: Caviedes
authors.forename: Luz
authors.initials: L
authors.lastname: Huaroto
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ticona
authors.forename: Jaime
authors.initials: J
authors.lastname: Ortiz
authors.forename: Marco
authors.initials: M
authors.lastname: Tovar
authors.forename: Victor
authors.initials: V
authors.lastname: Chavez
authors.forename: Richard
authors.initials: R
authors.lastname: Rodriguez
authors.forename: A Roderick
authors.initials: AR
authors.lastname: Escombe
authors.forename: Carlton A
authors.initials: CA
authors.lastname: Evans
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D000328:Adult; D018432:Drug Resistance, Multiple; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D010568:Peru / Q000453:epidemiology; D013183:Sputum / Q000469:parasitology / Q000821:virology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000401:mortality