PMID- 19555535
OWN - NLM
STAT- MEDLINE
DCOM- 20090918
LR  - 20211020
IS  - 1027-3719 (Print)
IS  - 1815-7920 (Electronic)
IS  - 1027-3719 (Linking)
VI  - 13
IP  - 7
DP  - 2009 Jul
TI  - Improved early results for patients with extensively drug-resistant tuberculosis 
      and HIV in South Africa.
PG  - 855-61
AB  - SETTING: A public tuberculosis (TB) referral hospital in KwaZulu-Natal, South 
      Africa. OBJECTIVE: To present treatment outcomes of patients with extensively 
      drug-resistant tuberculosis (XDR-TB) patients and human immunodeficiency virus 
      (HIV) coinfection with and without highly active antiretroviral therapy. METHODS: 
      Retrospective cohort study. Eligible patients had drug susceptibility testing 
      that met a consensus definition for XDR-TB, and agreed to treatment. Therapy was 
      based on drug susceptibilities, available medications and patient tolerance. 
      RESULTS: Overall, 60 XDR-TB patients initiated therapy with a median number of 
      5.5 drugs. Of these, 43 (72%) were HIV-positive, and 21 (49%) were on 
      antiretroviral therapy; 29 HIV-infected patients (67%) had available CD4 counts, 
      with a median CD4 count of 200.5 cells/mm(3) (standard deviation 127.4 
      cells/mm(3)). Of 60 patients, 31 (52%) had adverse events (AEs), and 17/60 
      patients (28%) had severe AEs. During follow-up, 12/60 (20%) experienced sputum 
      culture conversion, while 25/60 (42%) patients died. None of the following was 
      significantly associated with mortality: HIV status, previous MDR diagnosis or 
      severe AEs. DISCUSSION: In this study, it was possible to treat HIV-XDR-TB 
      coinfected patients and prolong survival in a resource-limited setting. We 
      highlight the challenges in treatment, including high frequencies of AEs and 
      death. Expanded identification of cases, prompt referral for treatment, and 
      attention to management of comorbidities may facilitate successful treatment of 
      XDR-TB in HIV-infected patients.
FAU - O'Donnell, Max R
AU  - O'Donnell MR
AD  - Section of Pulmonary, Allergy, and Critical Care Medicine, Boston University 
      School of Medicine, Boston, Massachusetts 02118, USA. modonn@bu.edu
FAU - Padayatchi, N
AU  - Padayatchi N
FAU - Master, I
AU  - Master I
FAU - Osburn, G
AU  - Osburn G
FAU - Horsburgh, C R
AU  - Horsburgh CR
LA  - eng
GR  - F32 AI084433/AI/NIAID NIH HHS/United States
GR  - F32 AI084433-01/AI/NIAID NIH HHS/United States
GR  - T32 AI052074/AI/NIAID NIH HHS/United States
GR  - T32 AI52074/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - France
TA  - Int J Tuberc Lung Dis
JT  - The international journal of tuberculosis and lung disease : the official journal 
      of the International Union against Tuberculosis and Lung Disease
JID - 9706389
RN  - 0 (Antitubercular Agents)
SB  - IM
MH  - AIDS-Related Opportunistic Infections/*drug therapy/epidemiology
MH  - Adult
MH  - *Antiretroviral Therapy, Highly Active
MH  - Antitubercular Agents/*therapeutic use
MH  - Female
MH  - HIV Infections/*complications/epidemiology
MH  - *HIV-1
MH  - Humans
MH  - Male
MH  - Microbial Sensitivity Tests
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - South Africa/epidemiology
MH  - Treatment Outcome
MH  - Tuberculosis, Multidrug-Resistant/*drug therapy/epidemiology
PMC - PMC2855970
MID - NIHMS188297
COIS- Conflict of Interest Statement: We declare that we have no conflict of interest.
EDAT- 2009/06/27 09:00
MHDA- 2009/09/19 06:00
PMCR- 2010/04/19
CRDT- 2009/06/27 09:00
PHST- 2009/06/27 09:00 [entrez]
PHST- 2009/06/27 09:00 [pubmed]
PHST- 2009/09/19 06:00 [medline]
PHST- 2010/04/19 00:00 [pmc-release]
PST - ppublish
SO  - Int J Tuberc Lung Dis. 2009 Jul;13(7):855-61.