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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Outcomes of multi-drug resistant tuberculosis (MDR-TB) among a cohort of South African patients with high HIV prevalence
PLoS ONE, Volume 6, No. 7, Article e20436, Year 2011
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Description
Background: Multidrug-resistant tuberculosis (MDR-TB) is a major clinical challenge, particularly in patients with human immunodeficiency virus (HIV) co-infection. MDR-TB treatment is increasingly available, but outcomes have not been well characterized. South Africa has provided MDR-TB treatment for a decade, and we evaluated outcomes by HIV status for patients enrolled between 2000 and 2004 prior to anti-retroviral access. Methods: We assessed treatment outcomes in a prospective cohort of patients with MDR-TB from eight provincial programs providing second line drugs. World Health Organization definitions were used. Results were stratified by HIV status. Results: Seven hundred fifty seven patients with known HIV status were included in the final analysis, and HIV infection was documented in 287 (38%). Overall, 348 patients (46.0%) were successfully treated, 74 (9.8%) failed therapy, 177 (23.4%) died and 158 (20.9%) defaulted. Patients with HIV were slightly younger and less likely to be male compared to HIV negative patients. Patients with HIV were less likely to have a successful treatment outcome (40.0 vs. 49.6; P<0.05) and more likely to die (35.2 vs. 16.2; P<0.0001). In a competing risk survival analysis, patients with HIV had a higher hazard of death (HR: 2.33, P<0.0001). Low baseline weight (less than 45 kg and less than 60 kg) was also associated with a higher hazard of death (HR: 2.52, P<0.0001; and HR: 1.50, P<0.0001, respectively, compared to weight greater than 60 kg). Weight less than 45 kg had higher risk of failure (HR: 3.58, P<0.01). Any change in treatment regimen was associated with a higher hazard of default (HR: 2.86; 95% CI 1.55-5.29, P<0.001) and a lower hazard of death (HR: 0.63, P<0.05). Conclusions: In this MDR-TB treatment program patients with HIV infection and low weight had higher hazards of death. Overall treatment outcomes were poor. Efforts to improve treatment for MDR-TB are urgently needed. © 2011 Farley et al.
Authors & Co-Authors
Farley, Jason E.
United States, Baltimore
Johns Hopkins School of Nursing
Ram, Malathi
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Pan, William K.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Waldman, Stacie
United States, Indianapolis
Eli Lilly and Company
Cassell, Gail H.
United States, Indianapolis
Eli Lilly and Company
Chaisson, Richard E.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
United States, Baltimore
School of Medicine
United States, Baltimore
Center for Tuberculosis Research
Weyer, Karin
South Africa, Tygerberg
South African Medical Research Council
Lancaster, Joey L.
South Africa, Tygerberg
South African Medical Research Council
van der Walt, Martie L.
South Africa, Tygerberg
South African Medical Research Council
Statistics
Citations: 129
Authors: 9
Affiliations: 6
Identifiers
Doi:
10.1371/journal.pone.0020436
e-ISSN:
19326203
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
South Africa
Participants Gender
Male