title: Predictors of cure among HIV co-infected multidrug-resistant TB patients at Sizwe Tropical Disease Hospital Johannesburg, South Africa.
abstract: BACKGROUND
  The global incidence of multidrug-resistant tuberculosis (MDR-TB) is rising, especially among HIV infected patients, despite intervention programs. Limited data are available on outcomes of MDR-TB treatment, specifically in a cohort of HIV co-infected patients in sub-Saharan Africa. The objective of this study was to determine the predictors of cure among MDR-TB HIV co-infected patients.
  
  
  METHODS
  A retrospective review of 1200 medical records of HIV co-infected MDR-TB patients was performed at Sizwe Tropical Disease Hospital, Johannesburg covering the period 2007 to 2010. Logistic regression analysis was done to identify predictors of cure.
  
  
  RESULTS
  Of 1137 patients included in the analysis, 29.8% (339/1137) were cured, 16.5% (188/1137) completed treatment, 22.3% (254/1137) defaulted treatment, 2.9% (33/1137) failed treatment and 22.7% (258/1137) died while on treatment. The remaining 5.7% (65/1137) were transferred-out or still-on-treatment. There was a significant interaction between sex and timing of antiretroviral treatment (ART) initiation (p=0.008). Factors predicting cure were male patients on ART prior to commencing MDR-TB treatment (OR 1.87, [1.11-3.13]), CD4(+) cell counts between 201-349 (OR 2.06, [1.10-3.84]) and ≥ 350 cells/mm³ (OR 1.98, [0.98-3.97]). Negative predictors of cure included the presence of cavitary lesions on chest x-rays (OR 0.55, [0.38-0.78]) and modified individualised regimen at baseline (OR 0.62, [0.42-0.92]).
  
  
  CONCLUSIONS
  Cure was higher in males on ART prior to initiating MDR-TB treatment compared with males on ART after initiating MDR-TB treatment. The inverse was the case among females. Therefore, future research should explore the biological and behavioural mechanisms that may possibly be responsible for this observed trend. This will help improve MDR-TB treatment outcomes in HIV co-infected patients on ART.
authors: Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors: Teye A
authors: TA
authors: Umanah
authors: Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors: Jabulani R
authors: JR
authors: Ncayiyana
authors: Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Department of Public Health, School of Health Sciences, Monash University, 144 Peter Road, Rumsuig, Johannesburg, South Africa peter.nyasulu@monash.edu.
authors: Peter S
authors: PS
authors: Nyasulu
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D000995:Antitubercular Agents / Q000008:administration & dosage*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents
keywords: Antiretroviral treatment; Human immunodeficiency virus; Multidrug-resistant tuberculosis; Sizwe Tropical Disease Hospital