title: Treatment outcomes for extensively drug-resistant tuberculosis and HIV co-infection.
abstract: High mortality rates have been reported for patients co-infected with extensively drug-resistant tuberculosis (XDR-TB) and HIV, but treatment outcomes have not been reported. We report treatment outcomes for adult XDR TB patients in KwaZulu-Natal Province, South Africa. Initial data were obtained retrospectively, and outcomes were obtained prospectively during 24 months of treatment. A total of 114 XDR TB patients were treated (median 6 drugs, range 3-9 drugs); 82 (73%) were HIV positive and 50 (61%) were receiving antiretroviral therapy. After receiving treatment for 24 months, 48 (42%) of 114 patients died, 25 (22%) were cured or successfully completed treatment, 19 (17%) withdrew from the study, and 22 (19%) showed treatment failure. A higher number of deaths occurred among HIV-positive patients not receiving antiretroviral therapy and among patients who did not show sputum culture conversion. Culture conversion was a major predictor of survival but was poorly predictive (51%) of successful treatment outcome.
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY 10461, USA. max.odonnell@einstein.yu.edu
authors.forename: Max R
authors.initials: MR
authors.lastname: O'Donnell
authors.forename: Nesri
authors.initials: N
authors.lastname: Padayatchi
authors.forename: Charlotte
authors.initials: C
authors.lastname: Kvasnovsky
authors.forename: Lise
authors.initials: L
authors.lastname: Werner
authors.forename: Iqbal
authors.initials: I
authors.lastname: Master
authors.forename: C Robert
authors.initials: CR
authors.lastname: Horsburgh
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000188:drug therapy* / Q000401:mortality; D003523:Cycloserine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000627:therapeutic use; D005000:Ethionamide / Q000627:therapeutic use; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011718:Pyrazinamide / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000401:mortality; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D003523:Cycloserine; D005000:Ethionamide
keywords: HIV; South Africa; XDR TB; bacteria; co-infection; extensively drug-resistant tuberculosis; treatment outcomes; tuberculosis and other mycobacteria; viruses