Management of extensively drug-resistant tuberculosis in Peru: cure is possible.
OBJECTIVE
To describe the incidence of extensive drug-resistant tuberculosis (XDR-TB) reported in the Peruvian National multidrug-resistant tuberculosis (MDR-TB) registry over a period of more than ten years and present the treatment outcomes for a cohort of these patients.


METHODS
From the Peruvian MDR-TB registry we extracted all entries that were approved for second-line anti-TB treatment between January 1997 and June of 2007 and that had Drug Susceptibility Test (DST) results indicating resistance to both rifampicin and isoniazid (i.e. MDR-TB) in addition to results for at least one fluoroquinolone and one second-line injectable (amikacin, capreomycin and kanamycin).


RESULTS
Of 1,989 confirmed MDR-TB cases with second-line DSTs, 119(6.0%) XDR-TB cases were detected between January 1997 and June of 2007. Lima and its metropolitan area account for 91% of cases, a distribution statistically similar to that of MDR-TB. A total of 43 XDR-TB cases were included in the cohort analysis, 37 of them received ITR. Of these, 17(46%) were cured, 8(22%) died and 11(30%) either failed or defaulted treatment. Of the 14 XDR-TB patients diagnosed as such before ITR treatment initiation, 10 (71%) were cured and the median conversion time was 2 months.


CONCLUSIONS
In the Peruvian context, with long experience in treating MDR-TB and low HIV burden, although the overall cure rate was poor, a large proportion of XDR-TB patients can be cured if DST to second-line drugs is performed early and treatment is delivered according to the WHO Guidelines.
Bonilla
Cesar A
CA
Ministry of Health, Lima, Peru.
Crossa
Aldo
A
Jave
Hector O
HO
Mitnick
Carole D
CD
Jamanca
Ronal B
RB
Herrera
Cesar
C
Asencios
Luis
L
Mendoza
Alberto
A
Bayona
Jaime
J
Zignol
Matteo
M
Jaramillo
Ernesto
E
D000995:Antitubercular Agents / Q000145:classification / Q000627:therapeutic use*; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination; D006801:Humans; D010568:Peru; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014376:Tuberculosis / Q000145:classification / Q000188:drug therapy*
D000995:Antitubercular Agents