title: High Treatment Success Rates Among HIV-Infected Multidrug-Resistant Tuberculosis Patients After Expansion of Antiretroviral Therapy in Botswana, 2006-2013.
abstract: Few studies have examined multidrug-resistant (MDR) tuberculosis (TB) treatment outcomes among HIV-infected persons after widespread expansion of antiretroviral therapy (ART). We describe MDR-TB treatment outcomes among HIV-infected and HIV-uninfected patients in Botswana after ART expansion.
  
  
  
  We retrospectively reviewed data from patients who started MDR-TB therapy in Botswana during 2006-2013. Multivariable regression models were used to compare treatment outcomes between HIV-infected and HIV-uninfected patients.
  
  
  
  We included 588 MDR-TB patients in the analysis, of whom, 47 (8.0%) and 9 (1.5%) were diagnosed with pre-extensively drug-resistant (XDR)-TB and XDR-TB, respectively. Of the 408 (69.4%) HIV-infected patients, 352 (86.0%) were on ART or started ART during treatment, and median baseline CD4 T-cell count was 234 cells/mm. Treatment success rates were 79.4% and 73.0% among HIV-uninfected and HIV-infected patients, respectively (P = 0.121). HIV-infected patients with CD4 T-cell count <100 cells/mm were more likely to die during treatment compared with HIV-uninfected patients (adjusted risk ratio = 1.890; 95% CI: 1.098 to 3.254).
  
  
  
  High rates of treatment success were achieved with programmatic management of MDR-TB and HIV in Botswana after widespread expansion of ART. However, a 2-fold increase in mortality was observed among HIV-infected persons with baseline CD4 <100 cells/mm compared with HIV-uninfected persons.
authors.affiliation: Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, US.
authors.forename: Sanghyuk S
authors.initials: SS
authors.lastname: Shin
authors.affiliation: Botswana-Upenn Partnership, Gaborone, Botswana.|Department of Infectious Disease, University of Pennsylvania School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, US.
authors.forename: Chawangwa
authors.initials: C
authors.lastname: Modongo
authors.affiliation: Centers for Disease Control and Prevention, University of Pennsylvania School of Medicine, Philadelphia, US.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Boyd
authors.affiliation: Princess Marina Hospital, Ministry of Health, University of Pennsylvania School of Medicine, Philadelphia, US.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Caiphus
authors.affiliation: TB Program, Ministry of Health, University of Pennsylvania School of Medicine, Philadelphia, US.
authors.forename: Lesego
authors.initials: L
authors.lastname: Kuate
authors.affiliation: TB Program, Ministry of Health, University of Pennsylvania School of Medicine, Philadelphia, US.
authors.forename: Botshelo
authors.initials: B
authors.lastname: Kgwaadira
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, US.
authors.forename: Nicola M
authors.initials: NM
authors.lastname: Zetola
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D000995:Antitubercular Agents / Q000008:administration & dosage*; D001902:Botswana; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000401:mortality; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents