title: Impact of drug-resistant tuberculosis on the survival of HIV-infected patients.
abstract: OBJECTIVE
  To determine the effect of drug-resistant tuberculosis (TB) on the survival of human immunodeficiency virus (HIV) infected patients in an area with a high prevalence of TB.
  
  
  METHODS
  Retrospective cohort study.
  
  
  RESULTS
  Of 225 HIV-TB patients with a mean age of 35.8 years, 72.4% were male. The median CD4 cell count at TB diagnosis was 44 cells/mm3. Sixty per cent presented with extra-pulmonary TB (EPTB). Sixty-three (28%) patients were infected with Mycobacterium tuberculosis resistant to at least one drug; respectively 16.4%, 9.3%, 5.3% and 12.9% were resistant to isoniazid (INH), rifampicin (RMP), ethambutol and streptomycin, and 14 (6.2%) had multidrug-resistant TB (MDR-TB). During a median follow-up of 11.5 months, 4% died. From Kaplan-Meier analysis, INH resistance, RMP resistance and MDR-TB were associated with shorter survival (log-rank test, P < 0.005). Cox's proportional hazard model showed that MDR-TB (hazard ratio [HR] 11.7; 95% CI 2.1-64.9), not receiving antiretroviral therapy (ART) (HR 7.9; 95% CI 1.5-43.1) and EPTB (HR 5.1; 95% CI 1.9-25.9) were significant risk factors for death.
  
  
  CONCLUSIONS
  MDR-TB and EPTB substantially reduce survival among patients co-infected with HIV and TB. Early detection and optimal treatment of MDR-TB are crucial. ART significantly prolongs survival and should be initiated in HIV-TB co-infected patients.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. rasuy@mahidol.ac.th
authors.forename: S
authors.initials: S
authors.lastname: Sungkanuparph
authors.forename: B
authors.initials: B
authors.lastname: Eampokalap
authors.forename: S
authors.initials: S
authors.lastname: Chottanapund
authors.forename: S
authors.initials: S
authors.lastname: Thongyen
authors.forename: W
authors.initials: W
authors.lastname: Manosuthi
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality*; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D018088:Tuberculosis, Multidrug-Resistant / Q000401:mortality*
chemical_list: D000995:Antitubercular Agents