Treatment Outcomes for Extensively Drug-Resistant Tuberculosis and HIV Co-infection

High mortality rates have been reported for patients co-infected with extensively drug-resistant tuberculosis (XDR-TB) and HIV, but treatment outcomes have not been reported. We report treatment outcomes for adult XDR TB patients in KwaZulu-Natal Province, South Africa. Initial data were obtained re...

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Vydáno v:	Emerging infectious diseases Ročník 19; číslo 3; s. 416 - 424
Hlavní autoři:	O’Donnell, Max R., Padayatchi, Nesri, Kvasnovsky, Charlotte, Werner, Lise, Master, Iqbal, Horsburgh, C. Robert
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States U.S. National Center for Infectious Diseases 01.03.2013 Centers for Disease Control and Prevention
Témata:	Adolescent Adult Antitubercular Agents - therapeutic use bacteria Care and treatment Coinfection - drug therapy Coinfection - mortality Comorbidity Cycloserine - therapeutic use Drug Therapy, Combination Ethambutol - therapeutic use Ethionamide - therapeutic use extensively drug-resistant tuberculosis Extensively Drug-Resistant Tuberculosis - drug therapy Extensively Drug-Resistant Tuberculosis - mortality Female HIV HIV infection HIV Infections - drug therapy HIV Infections - mortality Humans Kaplan-Meier Estimate Male Middle Aged Patient outcomes Pyrazinamide - therapeutic use Retrospective Studies Treatment Outcome Tuberculosis tuberculosis and other mycobacteria Tuberculosis, Pulmonary - drug therapy Tuberculosis, Pulmonary - mortality viruses XDR TB Young Adult United States viruses HIV bacteria co-infection treatment outcomes XDR TB extensively drug-resistant tuberculosis tuberculosis and other mycobacteria South Africa
ISSN:	1080-6040, 1080-6059, 1080-6059
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Abstract	High mortality rates have been reported for patients co-infected with extensively drug-resistant tuberculosis (XDR-TB) and HIV, but treatment outcomes have not been reported. We report treatment outcomes for adult XDR TB patients in KwaZulu-Natal Province, South Africa. Initial data were obtained retrospectively, and outcomes were obtained prospectively during 24 months of treatment. A total of 114 XDR TB patients were treated (median 6 drugs, range 3-9 drugs); 82 (73%) were HIV positive and 50 (61%) were receiving antiretroviral therapy. After receiving treatment for 24 months, 48 (42%) of 114 patients died, 25 (22%) were cured or successfully completed treatment, 19 (17%) withdrew from the study, and 22 (19%) showed treatment failure. A higher number of deaths occurred among HIV-positive patients not receiving antiretroviral therapy and among patients who did not show sputum culture conversion. Culture conversion was a major predictor of survival but was poorly predictive (51%) of successful treatment outcome.
AbstractList	Sputum culture conversion was poorly predictive of successful treatment. High mortality rates have been reported for patients co-infected with extensively drug-resistant tuberculosis (XDR-TB) and HIV, but treatment outcomes have not been reported. We report treatment outcomes for adult XDR TB patients in KwaZulu-Natal Province, South Africa. Initial data were obtained retrospectively, and outcomes were obtained prospectively during 24 months of treatment. A total of 114 XDR TB patients were treated (median 6 drugs, range 3–9 drugs); 82 (73%) were HIV positive and 50 (61%) were receiving antiretroviral therapy. After receiving treatment for 24 months, 48 (42%) of 114 patients died, 25 (22%) were cured or successfully completed treatment, 19 (17%) withdrew from the study, and 22 (19%) showed treatment failure. A higher number of deaths occurred among HIV-positive patients not receiving antiretroviral therapy and among patients who did not show sputum culture conversion. Culture conversion was a major predictor of survival but was poorly predictive (51%) of successful treatment outcome. High mortality rates have been reported for patients co-infected with extensively drug-resistant tuberculosis (XDR-TB) and HIV, but treatment outcomes have not been reported. We report treatment outcomes for adult XDR TB patients in KwaZulu-Natal Province, South Africa. Initial data were obtained retrospectively, and outcomes were obtained prospectively during 24 months of treatment. A total of 114 XDR TB patients were treated (median 6 drugs, range 3-9 drugs); 82 (73%) were HIV positive and 50 (61%) were receiving antiretroviral therapy. After receiving treatment for 24 months, 48 (42%) of 114 patients died, 25 (22%) were cured or successfully completed treatment, 19 (17%) withdrew from the study, and 22 (19%) showed treatment failure. A higher number of deaths occurred among HIV-positive patients not receiving antiretroviral therapy and among patients who did not show sputum culture conversion. Culture conversion was a major predictor of survival but was poorly predictive (51%) of successful treatment outcome.High mortality rates have been reported for patients co-infected with extensively drug-resistant tuberculosis (XDR-TB) and HIV, but treatment outcomes have not been reported. We report treatment outcomes for adult XDR TB patients in KwaZulu-Natal Province, South Africa. Initial data were obtained retrospectively, and outcomes were obtained prospectively during 24 months of treatment. A total of 114 XDR TB patients were treated (median 6 drugs, range 3-9 drugs); 82 (73%) were HIV positive and 50 (61%) were receiving antiretroviral therapy. After receiving treatment for 24 months, 48 (42%) of 114 patients died, 25 (22%) were cured or successfully completed treatment, 19 (17%) withdrew from the study, and 22 (19%) showed treatment failure. A higher number of deaths occurred among HIV-positive patients not receiving antiretroviral therapy and among patients who did not show sputum culture conversion. Culture conversion was a major predictor of survival but was poorly predictive (51%) of successful treatment outcome. High mortality rates have been reported for patients co-infected with extensively drug-resistant tuberculosis (XDR-TB) and HIV, but treatment outcomes have not been reported. We report treatment outcomes for adult XDR TB patients in KwaZulu-Natal Province, South Africa. Initial data were obtained retrospectively, and outcomes were obtained prospectively during 24 months of treatment. A total of 114 XDR TB patients were treated (median 6 drugs, range 3–9 drugs); 82 (73%) were HIV positive and 50 (61%) were receiving antiretroviral therapy. After receiving treatment for 24 months, 48 (42%) of 114 patients died, 25 (22%) were cured or successfully completed treatment, 19 (17%) defaulted from the study, and 22 (19%) showed treatment failure. A higher number of deaths occurred among HIV-positive patients not receiving antiretroviral therapy and among patients who did not show sputum culture conversion. Culture conversion was a major predictor of survival but was poorly predictive (51%) of successful treatment outcome. High mortality rates have been reported for patients co-infected with extensively drug-resistant tuberculosis (XDR-TB) and HIV, but treatment outcomes have not been reported. We report treatment outcomes for adult XDR TB patients in KwaZulu-Natal Province, South Africa. Initial data were obtained retrospectively, and outcomes were obtained prospectively during 24 months of treatment. A total of 114 XDR TB patients were treated (median 6 drugs, range 3-9 drugs); 82 (73%) were HIV positive and 50 (61%) were receiving antiretroviral therapy. After receiving treatment for 24 months, 48 (42%) of 114 patients died, 25 (22%) were cured or successfully completed treatment, 19 (17%) withdrew from the study, and 22 (19%) showed treatment failure. A higher number of deaths occurred among HIV-positive patients not receiving antiretroviral therapy and among patients who did not show sputum culture conversion. Culture conversion was a major predictor of survival but was poorly predictive (51%) of successful treatment outcome.
Audience	Professional Academic
Author	Kvasnovsky, Charlotte O’Donnell, Max R. Horsburgh, C. Robert Werner, Lise Padayatchi, Nesri Master, Iqbal
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BackLink	https://www.ncbi.nlm.nih.gov/pubmed/23622055$$D View this record in MEDLINE/PubMed
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Keywords	viruses HIV bacteria co-infection treatment outcomes XDR TB extensively drug-resistant tuberculosis tuberculosis and other mycobacteria South Africa
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Snippet	High mortality rates have been reported for patients co-infected with extensively drug-resistant tuberculosis (XDR-TB) and HIV, but treatment outcomes have not... Sputum culture conversion was poorly predictive of successful treatment. High mortality rates have been reported for patients co-infected with extensively...
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SubjectTerms	Adolescent Adult Antitubercular Agents - therapeutic use bacteria Care and treatment Coinfection - drug therapy Coinfection - mortality Comorbidity Cycloserine - therapeutic use Drug Therapy, Combination Ethambutol - therapeutic use Ethionamide - therapeutic use extensively drug-resistant tuberculosis Extensively Drug-Resistant Tuberculosis - drug therapy Extensively Drug-Resistant Tuberculosis - mortality Female HIV HIV infection HIV Infections - drug therapy HIV Infections - mortality Humans Kaplan-Meier Estimate Male Middle Aged Patient outcomes Pyrazinamide - therapeutic use Retrospective Studies Treatment Outcome Tuberculosis tuberculosis and other mycobacteria Tuberculosis, Pulmonary - drug therapy Tuberculosis, Pulmonary - mortality viruses XDR TB Young Adult
Title	Treatment Outcomes for Extensively Drug-Resistant Tuberculosis and HIV Co-infection
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