Early outcomes of MDR-TB treatment in a high HIV-prevalence setting in Southern Africa.
BACKGROUND
Little is known about treatment of multidrug-resistant tuberculosis (MDR-TB) in high HIV-prevalence settings such as sub-Saharan Africa.


RESULTS
We did a retrospective analysis of early outcomes of the first cohort of patients registered in the Lesotho national MDR-TB program between July 21, 2007 and April 21, 2008. Seventy-six patients were included for analysis. Patient follow-up ended when an outcome was recorded, or on October 21, 2008 for those still on treatment. Fifty-six patients (74%) were infected with HIV; the median CD4 cell count was 184 cells/microl (range 5-824 cells/microl). By the end of the follow-up period, study patients had been followed for a median of 252 days (range 12-451 days). Twenty-two patients (29%) had died, and 52 patients (68%) were alive and in treatment. In patients who did not die, culture conversion was documented in 52/54 patients (96%). One patient had defaulted, and one patient had transferred out. Death occurred after a median of 66 days in treatment (range 12-374 days).


CONCLUSIONS
In a region where clinicians and program managers are increasingly confronted by drug-resistant tuberculosis, this report provides sobering evidence of the difficulty of MDR-TB treatment in high HIV-prevalence settings. In Lesotho, an innovative community-based treatment model that involved social and nutritional support, twice-daily directly observed treatment and early empiric use of second-line TB drugs was successful in reducing mortality of MDR-TB patients. Further research is urgently needed to improve MDR-TB treatment outcomes in high HIV-prevalence settings.
Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America. kjseung@pih.org
Kwonjune J
KJ
Seung
David B
DB
Omatayo
Salmaan
S
Keshavjee
Jennifer J
JJ
Furin
Paul E
PE
Farmer
Hind
H
Satti
D000293:Adolescent; D000328:Adult; D000353:Africa, Southern; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism / Q000821:virology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*