title: High risk of drug-resistant tuberculosis when first-line therapy fails in a high HIV prevalence setting.
abstract: METHODS
  Lesotho national multidrug-resistant tuberculosis (MDR-TB) program.
  
  
  OBJECTIVE
  To determine the prevalence of drug-resistant TB (DR-TB) among patients registered for MDR-TB treatment after failure or suspected failure of the standard 6-month regimen for new TB patients (Category  I).
  
  
  METHODS
  We conducted a retrospective cohort study of patients registered for MDR-TB treatment following failure or suspected failure of Category I.
  
  
  RESULTS
  A total of 76 patients were included in the analysis, including 51 Category I treatment failures and 25 suspected Category  I treatment failures. The prevalence of resistance to any drug was 92% among the treatment failures and 72% among the suspected failures. The proportion of MDR-TB was respectively 78% and 28% among the treatment failures and suspected failures. Among the subgroup of human immunodeficiency  virus (HIV) positive patients, the proportion of MDR-TB was 84% among failures and 23% among suspected failures.
  
  
  CONCLUSIONS
  DR-TB and MDR-TB were common among patients in whom Category I failed. Early initiation of empiric second-line anti-tuberculosis treatment while awaiting culture  and drug susceptibility testing (DST) results should be considered for HIV-negative and -positive patients who have failed first-line anti-tuberculosis treatment; patients suspected to be failing a first-line regimen should undergo DST at the end of the intensive phase.
authors.affiliation: Partners In Health, Maseru, Lesotho. hsatti@pih.org
authors.forename: H
authors.initials: H
authors.lastname: Satti
authors.forename: M M
authors.initials: MM
authors.lastname: McLaughlin
authors.forename: K J
authors.initials: KJ
authors.lastname: Seung
authors.forename: M C
authors.initials: MC
authors.lastname: Becerra
authors.forename: S
authors.initials: S
authors.lastname: Keshavjee
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007927:Lesotho / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*