Culture conversion among HIV co-infected multidrug-resistant tuberculosis patients in Tugela Ferry, South Africa.
BACKGROUND
Little is known about the time to sputum culture conversion in MDR-TB patients co-infected with HIV, although such patients have, historically, had poor outcomes. We describe culture conversion rates among MDR-TB patients with and without HIV-co-infection in a TB-endemic, high-HIV prevalent, resource-limited setting.


METHODS
Patients with culture-proven MDR-TB were treated with a standardized second-line regimen. Sputum cultures were taken monthly and conversion was defined as two negative cultures taken at least one month apart. Time-to-conversion was measured from the day of initiation of MDR-TB therapy. Subjects with HIV received antiretroviral therapy (ART) regardless of CD4 count.


RESULTS
Among 45 MDR-TB patients, 36 (80%) were HIV-co-infected. Overall, 40 (89%) of the 45 patients culture-converted within the first six months and there was no difference in the proportion who converted based on HIV status. Median time-to-conversion was 62 days (IQR 48-111). Among the five patients who did not culture convert, three died, one was transferred to another facility, and one refused further treatment before completing 6 months of therapy. Thus, no patients remained persistently culture-positive at 6 months of therapy.


CONCLUSIONS
With concurrent second-line TB and ART medications, MDR-TB/HIV co-infected patients can achieve culture conversion rates and times similar to those reported from HIV-negative patients worldwide. Future studies are needed to examine whether similar cure rates are achieved at the end of MDR-TB treatment and to determine the optimal use and timing of ART in the setting of MDR-TB treatment.
Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, United States of America. jcmbrust@gmail.com
James C M
JC
Brust
Melissa
M
Lygizos
Krisda
K
Chaiyachati
Michelle
M
Scott
Theo L
TL
van der Merwe
Anthony P
AP
Moll
Xuan
X
Li
Marian
M
Loveday
Sheila A
SA
Bamber
Umesh G
UG
Lalloo
Gerald H
GH
Friedland
N Sarita
NS
Shah
Neel R
NR
Gandhi
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D012074:Remission Induction; D012189:Retrospective Studies; D013019:South Africa; D013183:Sputum / Q000382:microbiology / Q000821:virology; D013997:Time Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000188:drug therapy; D055815:Young Adult
D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents
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