title: Impact of the human immunodeficiency virus on early multidrug-resistant tuberculosis treatment outcomes in Botswana.
abstract: METHODS
  The impact of the human immunodeficiency virus (HIV) on multidrug-resistant tuberculosis (MDR-TB) treatment outcomes in sub-Saharan Africa, where extensive rollout of highly active antiretroviral therapy (HAART) has occurred, remains unclear.
  
  
  OBJECTIVE
  To compare the time  to initial culture conversion among patients with and those without HIV infection in a setting of individualized MDR-TB care in Botswana.
  
  
  METHODS
  Prospective cohort study of MDR-TB patients receiving ambulatory, integrated TB-HIV care at two public clinics in Botswana. The time to culture  conversion was compared by HIV status using Cox proportional hazard ratios (HRs).
  
  
  RESULTS
  A total of 40 HIV-infected and 30 non-HIV-infected patients with MDR-TB and follow-up cultures were identified. The median time to initial culture conversion was 78 days (interquartile range [IQR]  42-186) for HIV-infected and 95 days (IQR 70-133) for non-HIV-infected individuals (log rank P > 0.5; unadjusted HR 0.9, 95%CI 0.5-1.5). Adjusting for age, sex, treatment history and number of active anti-tuberculosis drugs did not change this result (adjusted HR  0.8, 95%CI 0.4-1.4).
  
  
  CONCLUSIONS
  We found no difference in the proportion of or time to initial sputum culture conversion between an HIV-infected and a non-infected cohort of MDR-TB patients in Botswana, suggesting that outcomes may be comparable in similar settings with access to  individualized anti-tuberculosis treatment and HAART.
authors: Botswana UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA. hafkin@gmail.com
authors: J
authors: J
authors: Hafkin
authors: C
authors: C
authors: Modongo
authors: C
authors: C
authors: Newcomb
authors: E
authors: E
authors: Lowenthal
authors: R R
authors: RR
authors: MacGregor
authors: A P
authors: AP
authors: Steenhoff
authors: H
authors: H
authors: Friedman
authors: G P
authors: GP
authors: Bisson
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001902:Botswana / Q000453:epidemiology; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010865:Pilot Projects; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents