Culture Conversion Among HIV Co-Infected Multidrug-Resistant Tuberculosis Patients in Tugela Ferry, South Africa

Little is known about the time to sputum culture conversion in MDR-TB patients co-infected with HIV, although such patients have, historically, had poor outcomes. We describe culture conversion rates among MDR-TB patients with and without HIV-co-infection in a TB-endemic, high-HIV prevalent, resourc...

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Vydáno v:	PloS one Ročník 6; číslo 1; s. e15841
Hlavní autoři:	Brust, James C. M., Lygizos, Melissa, Chaiyachati, Krisda, Scott, Michelle, van der Merwe, Theo L., Moll, Anthony P., Li, Xuan, Loveday, Marian, Bamber, Sheila A., Lalloo, Umesh G., Friedland, Gerald H., Shah, N. Sarita, Gandhi, Neel R.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Public Library of Science 06.01.2011 Public Library of Science (PLoS)
Témata:	Adult Anti-Retroviral Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Antitubercular Agents - therapeutic use Biology Care and treatment CD4 antigen Clinical outcomes Collaboration Conversion Culture Drug resistance Drug therapy Epidemiology Female Health aspects Highly active antiretroviral therapy Historical account HIV HIV Infections - complications HIV Infections - drug therapy Human immunodeficiency virus Humans Infections Male Medical schools Medicine Microbial drug resistance Mortality Multidrug resistance Multidrug resistant organisms Mycobacterium Patients Physicians Population Remission Induction Retrospective Studies Rural areas South Africa Sputum Sputum - microbiology Sputum - virology Task forces Therapy Time Factors Tuberculosis Tuberculosis, Multidrug-Resistant - complications Tuberculosis, Multidrug-Resistant - drug therapy Young Adult South Africa New York Ann Arbor Michigan United States > US Michigan
ISSN:	1932-6203, 1932-6203
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Shrnutí:	Little is known about the time to sputum culture conversion in MDR-TB patients co-infected with HIV, although such patients have, historically, had poor outcomes. We describe culture conversion rates among MDR-TB patients with and without HIV-co-infection in a TB-endemic, high-HIV prevalent, resource-limited setting. Patients with culture-proven MDR-TB were treated with a standardized second-line regimen. Sputum cultures were taken monthly and conversion was defined as two negative cultures taken at least one month apart. Time-to-conversion was measured from the day of initiation of MDR-TB therapy. Subjects with HIV received antiretroviral therapy (ART) regardless of CD4 count. Among 45 MDR-TB patients, 36 (80%) were HIV-co-infected. Overall, 40 (89%) of the 45 patients culture-converted within the first six months and there was no difference in the proportion who converted based on HIV status. Median time-to-conversion was 62 days (IQR 48-111). Among the five patients who did not culture convert, three died, one was transferred to another facility, and one refused further treatment before completing 6 months of therapy. Thus, no patients remained persistently culture-positive at 6 months of therapy. With concurrent second-line TB and ART medications, MDR-TB/HIV co-infected patients can achieve culture conversion rates and times similar to those reported from HIV-negative patients worldwide. Future studies are needed to examine whether similar cure rates are achieved at the end of MDR-TB treatment and to determine the optimal use and timing of ART in the setting of MDR-TB treatment.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Article-2 ObjectType-Feature-1 Conceived and designed the experiments: JCMB ML KC MS APM UGL GHF NSS NRG. Performed the experiments: JCMB ML KC MS TLvdM APM SAB. Analyzed the data: JCMB ML KC XL NSS NRG. Wrote the paper: JCMB KC ML UGL GHF NSS NRG.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0015841