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Risk factors for mortality among MDR- and XDR-TB patients in a high HIV prevalence setting

Authors: Gandhi, N. R.1; Andrews, J. R.2; Brust, J. C. M.3; Montreuil, R.3; Weissman, D.3; Heo, M.4; Moll, A. P.5; Friedland, G. H.6; Shah, N. S.1

Source: The International Journal of Tuberculosis and Lung Disease, Volume 16, Number 1, 1 January 2012 , pp. 90-97(8)

Publisher: International Union Against Tuberculosis and Lung Disease

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Abstract:

SETTING: Recent studies suggest that the prevalence of drug-resistant tuberculosis (TB) in sub-Saharan Africa may be rising. This is of concern, as human immunodeficiency virus (HIV) co-infection in multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB has been associated with exceedingly high mortality rates.

OBJECTIVE: To identify risk factors associated with mortality in MDR- and XDR-TB patients co-infected with HIV in South Africa.

DESIGN: Case-control study of patients who died of all causes within 2 years of diagnosis with MDR- or XDR-TB.

RESULTS: Among 123 MDR-TB patients, 78 (63%) died following diagnosis. CD4 count ≤ 50 (HR 4.64, P = 0.01) and 51–200 cells/mm3 (HR 4.17, P = 0.008) were the strongest independent risk factors for mortality. Among 139 XDR-TB patients, 111 (80%) died. CD4 count ≤50 cells/mm3 (HR 4.46, P = 0.01) and resistance to all six drugs tested (HR 2.54, P = 0.04) were the principal risk factors. Use of antiretroviral therapy (ART) was protective (HR 0.34, P = 0.009).

CONCLUSIONS: Mortality due to MDR- and XDR-TB was associated with greater degree of immunosuppression and drug resistance. Efforts to reduce mortality must focus on preventing the amplification of resistance by strengthening TB treatment programs, as well as reducing the pool of immunosuppressed HIV-infected patients through aggressive HIV testing and ART initiation.

Keywords: MDR-TB; TB-HIV co-infection; XDR-TB; mortality; risk factors

Document Type: Research Article

DOI: http://dx.doi.org/10.5588/ijtld.11.0153

Affiliations: 1: Department of Medicine and Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA 2: Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA 3: Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA 4: Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA 5: Philanjalo and Church of Scotland Hospital, Tugela Ferry, KwaZulu-Natal, South Africa 6: Yale University School of Medicine, New Haven, Connecticut, USA

Publication date: January 1, 2012

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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