title: Chest radiograph findings and time to culture conversion in patients with multidrug-resistant tuberculosis and HIV in Tugela Ferry, South Africa.
abstract: BACKGROUND
  The majority of patients with multidrug-resistant tuberculosis (MDR-TB) in South Africa are co-infected with HIV, but the radiographic features of MDR-TB and their relationship with time to sputum culture conversion in the antiretroviral therapy era have not been described.
  
  
  METHODS
  We reviewed baseline chest radiographs for 56 patients with MDR-TB from a rural area of South Africa. We analyzed the association of cavities, consolidation, pleural effusion and hilar lymphadenopathy with time to sputum culture conversion, adjusting for HIV status, baseline sputum smear and CD4 count.
  
  
  RESULTS
  Of the 56 subjects, 49 (88%) were HIV-positive, with a median CD4 count of 136 cells/mm(3) (IQR 65-249). Thirty-two (57%) patients were sputum smear positive. Twenty-two (39%) patients had a cavity and 37 (66%) patients had consolidations. Cavitary disease and consolidations were each associated with longer time to culture conversion on bivariate analysis but not after adjusting for sputum smear status (aORs 1.79 [0.94-3.42] and 1.09 [0.67-1.78], respectively). Positive baseline sputum smear remained independently associated with longer time to conversion (aOR 3.45 [1.39-8.59]). We found no association between pleural effusion or hilar lymphadenopathy and time to conversion. Seventy-nine percent of patients were cured at the end of treatment.
  
  
  CONCLUSIONS
  Despite high rates of HIV co-infection and advanced immunodeficiency, the majority of patients had severe pathology on baseline chest radiograph. Nevertheless, culture conversion rates were high and treatment outcomes were favorable. Cavitation and consolidation do not appear to have an independent association with time to culture conversion beyond that of baseline sputum smear status.
authors.affiliation: Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York, United States of America.
authors.forename: James C M
authors.initials: JC
authors.lastname: Brust
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Berman
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zalta
authors.forename: Linda B
authors.initials: LB
authors.lastname: Haramati
authors.forename: Yuming
authors.initials: Y
authors.lastname: Ning
authors.forename: Moonseong
authors.initials: M
authors.lastname: Heo
authors.forename: Theo L
authors.initials: TL
authors.lastname: van der Merwe
authors.forename: Sheila
authors.initials: S
authors.lastname: Bamber
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Moll
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Friedland
authors.forename: N Sarita
authors.initials: NS
authors.lastname: Shah
authors.forename: Neel R
authors.initials: NR
authors.lastname: Gandhi
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D013902:Radiography, Thoracic; D013019:South Africa; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents
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