Improved early results for patients with extensively drug-resistant tuberculosis and HIV in South Africa

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) co-infection 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/mm3 (standard deviation 127.4 cells/mm3). 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. © 2009 The Union.