Abstract
BackgroundAlthough the importance of concurrent treatment for multidrug-resistant tuberculosis (MDR-TB) and HIV co-infection has been increasingly recognized, there have been few studies reporting outcomes of MDR-TB and HIV co-treatment. We report final outcomes of comprehensive, integrated MDR-TB and HIV treatment in Lesotho and examine factors associated with death or treatment failure.MethodsWe reviewed clinical charts of all adult patients who initiated MDR-TB treatment in Lesotho between January 2008 and September 2009. We calculated hazard ratios (HR) and used multivariable Cox proportional hazards regression to identify predictors of poor outcomes.ResultsOf 134 confirmed MDR-TB patients, 83 (62%) were cured or completed treatment, 46 (34%) died, 3 (2%) transferred, 1 (1%) defaulted, and 1 (1%) failed treatment. Treatment outcomes did not differ significantly by HIV status. Among the 94 (70%) patients with HIV co-infection, 53% were already on antiretroviral therapy (ART) before MDR-TB treatment initiation, and 43% started ART a median of 16 days after the start of the MDR-TB regimen. Among HIV co-infected patients who died, those who had not started ART before MDR-TB treatment had a shorter median time to death (80 days vs. 138 days, p = 0.065). In multivariable analysis, predictors of increased hazard of failure or death were low and severely low body mass index (HR 2.75, 95% confidence interval [CI] 1.27–5.93; HR 5.50, 95% CI 2.38–12.69), and a history of working in South Africa (HR 2.37, 95% CI 1.24–4.52).ConclusionsFavorable outcomes can be achieved in co-infected patients using a community-based treatment model when both MDR-TB and HIV disease are treated concurrently and treatment is initiated promptly.
Highlights
The convergence of the drug-resistant tuberculosis (DR-TB) and HIV epidemics represents a growing threat to public health
Patients with suspected multidrug-resistant tuberculosis (MDR-TB) who did not have drug susceptibility testing (DST) results at the time of referral were classified by risk level according to their treatment history and clinical, bacteriological, and radiological criteria [26]
Patient Selection In September 2011, we retrospectively reviewed the clinical charts of patients in the Lesotho national MDR-TB program who initiated second-line TB treatment between January 1, 2008 and September 29, 2009
Summary
The convergence of the drug-resistant tuberculosis (DR-TB) and HIV epidemics represents a growing threat to public health. There have been many well-documented outbreaks of multidrug-resistant (MDR) TB among HIV-positive patients in Europe and the US [4,5,6,7,8]. DR-TB has not been thought to be a significant problem in African countries, many of which have generalized HIV epidemics, but most of these countries do not have the laboratory capacity for drug resistance surveillance [9]. The importance of concurrent treatment for multidrug-resistant tuberculosis (MDR-TB) and HIV coinfection has been increasingly recognized, there have been few studies reporting outcomes of MDR-TB and HIV cotreatment. We report final outcomes of comprehensive, integrated MDR-TB and HIV treatment in Lesotho and examine factors associated with death or treatment failure
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