HIV-positive patients treated for multidrug-resistant tuberculosis: clinical outcomes in the HAART era.
METHODS
Multidrug-resistant tuberculosis (MDR-TB) and the human immunodeficiency virus (HIV) pose two of the greatest threats to global tuberculosis (TB) control. Given expanding global access to antiretroviral therapy (ART) and second-line TB drugs, more data are needed on experiences  treating MDR-TB and HIV co-infection in resource-poor settings.


OBJECTIVE
To describe the clinical characteristics, management, outcomes, and factors associated with survival among HIV-positive individuals receiving treatment for MDR-TB.


METHODS
This was a retrospective case series  of 52 HIV-positive individuals receiving treatment for MDR-TB in Lima, Peru. We used Cox proportional hazards regression models to identify risk factors for mortality.


RESULTS
A total of 31 (57%) of the cohort died on treatment, with the majority of deaths due to MDR-TB. Low baseline weight  predicted a three-fold increased rate of death (aHR 3.1, 95%CI 1.5-6.7), while individuals receiving highly active ART experienced a significantly lower rate of death compared to those who were not (aHR 0.4, 95%CI 0.2-0.9).


CONCLUSIONS
Early ART is likely a key component of  effective MDR-TB management in co-infected individuals.
Socios En Salud, Sucursal Peru, Lima, Peru.
E
E
Palacios
M
M
Franke
M
M
Muñoz
R
R
Hurtado
R
R
Dallman
K
K
Chalco
D
D
Guerra
L
L
Mestanza
K
K
Llaro
C
C
Bonilla
J
J
Sebastian
J
J
Bayona
M
M
Lygizos
M
M
Lyzigos
H
H
Anger
S
S
Shin
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D000995:Antitubercular Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010568:Peru / Q000453:epidemiology; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
D019380:Anti-HIV Agents; D000995:Antitubercular Agents