title: Extensively drug-resistant TB in Eastern Cape, South Africa: high mortality in HIV-negative and HIV-positive patients.
abstract: BACKGROUND
  Tuberculosis is a leading cause of morbidity and mortality worldwide. Patients with extensively drug-resistant tuberculosis (XDR-TB) have had high mortality rates, especially when coinfected with HIV.
  
  
  METHODS
  A retrospective cohort study of the first 206 patients treated for XDR-TB in Eastern Cape Province, South Africa, October 2006 to January 2008, a province that has treated multidrug-resistant tuberculosis since 2000. All 206 patients were hospitalized for treatment until monthly sputum specimens were culture negative.
  
  
  RESULTS
  Sixty-five patients diagnosed with XDR-TB died before XDR-TB treatment start. Among 195 patients starting treatment with a known HIV status, 108 (55.4%) were HIV positive, and 86 patients (44.1%) died during the first year of treatment. HIV-positive patients receiving antiretroviral treatment (ARVs) fared and HIV-negative patients, and more of both these groups survived than HIV-positive patients not on ARVs. However, HIV-negative patients experienced more serious adverse events requiring the withdrawal of medications than did HIV-positive patients, regardless of the use of ARVs.
  
  
  CONCLUSIONS
  Experience in Eastern Cape Province, South Africa, suggests that patients can be treated for both XDR-TB and HIV. We have also shown that such combination therapy can be well tolerated by patients.
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA. ckvasnovsky@smail.umaryland.edu
authors.forename: Charlotte L
authors.initials: CL
authors.lastname: Kvasnovsky
authors.forename: J Peter
authors.initials: JP
authors.lastname: Cegielski
authors.forename: Roshen
authors.initials: R
authors.lastname: Erasmus
authors.forename: N Olga
authors.initials: NO
authors.lastname: Siwisa
authors.forename: Khulile
authors.initials: K
authors.lastname: Thomas
authors.forename: Martie L van
authors.initials: ML
authors.lastname: der Walt
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D015331:Cohort Studies; D024901:Drug Resistance, Multiple, Bacterial; D054908:Extensively Drug-Resistant Tuberculosis / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents