title: A retrospective review comparing treatment outcomes of adjuvant lung resection for drug-resistant tuberculosis in patients with and without human immunodeficiency virus co-infection.
abstract: OBJECTIVE
  This review was undertaken to compare treatment outcomes in human immunodeficiency virus (HIV) negative versus HIV-positive patients following adjuvant lung resection for drug-resistant tuberculosis (DR-TB) in patients deemed feasible for surgery. Despite appropriate medical therapy, mortality remains extremely high and cure rates poor in patients with DR-TB and HIV co-infection. Therefore, adjuvant lung resection may warrant a more prominent role in the treatment of these patients.
  
  
  METHODS
  A retrospective review of all case records from 1 January 2012 to 31 March 2013 of all patients admitted to the Department of Cardiothoracic Surgery King Dinuzulu Hospital with DR-TB and treated with adjuvant lung resection was undertaken. Prior to surgery, all patients were treated for at least 3 months with appropriate drug therapy for DR-TB. This was continued for the recommended period following lung resection.
  
  
  RESULTS
  Fourteen patients with extensively drug-resistant tuberculosis (XDR-TB) were deemed suitable for lung resection. Of these patients, 10 patients were HIV-positive and 4 were HIV-negative. In the XDR-TB/HIV-positive group, 7 patients were cured, 2 converted and 2 patients developed a post-pneumonectomy broncho-pleural fistula. One patient was lost to follow-up. In the XDR-TB/HIV-negative group, 1 patient was cured, 3 converted and 1 patient developed a post-thoracotomy superficial wound infection. There was no in-hospital mortality in both groups. Thirty-six patients with multi-drug-resistant tuberculosis (MDR-TB) were deemed suitable for lung resection. Of these patients, 19 were HIV-positive and 17 HIV-negative. In the MDR-TB/HIV-positive group, 12 patients were cured and 6 converted. One patient developed a post-thoracotomy superficial wound infection and another patient who developed a post-pneumonectomy empyema thoracis was also regarded as a treatment failure. In the MDR-TB/HIV-negative group, 15 patients were cured, 2 converted and 1 patient developed a post-pneumonectomy lower respiratory tract infection which necessitated a short period of mechanical ventilation. There was no in-hospital mortality in both groups.
  
  
  CONCLUSIONS
  Lung resection for DR-TB may be safely undertaken in selected patients who are HIV-positive with cure rates equivalent to that of HIV-negative patients. More importantly, these patients also have significantly higher cure rates than those patients treated with medical therapy alone.
authors.affiliation: King Dinuzulu Hospital, Durban, South Africa mdalexg@hotmail.com.
authors.forename: Gerard R
authors.initials: GR
authors.lastname: Alexander
authors.affiliation: King Dinuzulu Hospital, Durban, South Africa Department of Anaesthesiology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
authors.forename: Bruce
authors.initials: B
authors.lastname: Biccard
mesh_terms: D000328:Adult; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult
keywords: Lobectomy; Lung pathology; Tuberculosis