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Multicenter Study
. 2013 Mar;17(3):348-53.
doi: 10.5588/ijtld.12.0100. Epub 2013 Jan 14.

Impact of the human immunodeficiency virus on early multidrug-resistant tuberculosis treatment outcomes in Botswana

J Hafkin  1 , C Modongo, C Newcomb, E Lowenthal, R R MacGregor, A P Steenhoff, H Friedman, G P Bisson
Affiliations
Multicenter Study

Impact of the human immunodeficiency virus on early multidrug-resistant tuberculosis treatment outcomes in Botswana

J Hafkin et al. Int J Tuberc Lung Dis. 2013 Mar.

Abstract

Setting: The impact of the human immunodeficiency virus (HIV) on multidrug-resistant tuberculosis (MDR-TB) treatment outcomes in sub-Saharan Africa, where extensive rollout of highly active antiretroviral therapy (HAART) has occurred, remains unclear.

Objective: To compare the time to initial culture conversion among patients with and those without HIV infection in a setting of individualized MDR-TB care in Botswana.

Design: Prospective cohort study of MDR-TB patients receiving ambulatory, integrated TB-HIV care at two public clinics in Botswana. The time to culture conversion was compared by HIV status using Cox proportional hazard ratios (HRs).

Results: A total of 40 HIV-infected and 30 non-HIV-infected patients with MDR-TB and follow-up cultures were identified. The median time to initial culture conversion was 78 days (interquartile range [IQR] 42-186) for HIV-infected and 95 days (IQR 70-133) for non-HIV-infected individuals (log rank P > 0.5; unadjusted HR 0.9, 95%CI 0.5-1.5). Adjusting for age, sex, treatment history and number of active anti-tuberculosis drugs did not change this result (adjusted HR 0.8, 95%CI 0.4-1.4).

Conclusion: We found no difference in the proportion of or time to initial sputum culture conversion between an HIV-infected and a non-infected cohort of MDR-TB patients in Botswana, suggesting that outcomes may be comparable in similar settings with access to individualized anti-tuberculosis treatment and HAART.

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Conflict of interest statement

Conflict of interest: none declared.

Figures

Figure
Figure
Kaplan-Meier curves comparing time to culture clearance by HIV status. HIV = human immunodeficiency virus.
See this image and copyright information in PMC

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