Treatment outcomes for extensively drug-resistant tuberculosis and HIV co-infection

Abstract

High mortality rates have been reported for patients co-infected with extensively drug-resistant tuberculosis (XDR-TB) and HIV, but treatment outcomes have not been reported. We report treatment outcomes for adult XDR TB patients in KwaZulu-Natal Province, South Africa. Initial data were obtained retrospectively, and outcomes were obtained prospectively during 24 months of treatment. A total of 114 XDR TB patients were treated (median 6 drugs, range 3-9 drugs); 82 (73%) were HIV positive and 50 (61%) were receiving antiretroviral therapy. After receiving treatment for 24 months, 48 (42%) of 114 patients died, 25 (22%) were cured or successfully completed treatment, 19 (17%) withdrew from the study, and 22 (19%) showed treatment failure. A higher number of deaths occurred among HIV-positive patients not receiving antiretroviral therapy and among patients who did not show sputum culture conversion. Culture conversion was a major predictor of survival but was poorly predictive (51%) of successful treatment outcome.

Keywords: HIV; South Africa; XDR TB; bacteria; co-infection; extensively drug-resistant tuberculosis; treatment outcomes; tuberculosis and other mycobacteria; viruses.

Figure 1

Kaplan-Meier curves for A) 114 HIV-positive (dashed line) and HIV-negative (solid line) patients receiving treatment for extensively drug-resistant tuberculosis (XDR TB) (p = 0.4966); and B) 82 HIV-infected patients with XDR TB receiving (dashed line) and not receiving (solid line) antiretroviral therapy (p = 0.0330), KwaZulu-Natal Province, South Africa. p values were adjusted for sex, TB treatment history, and HIV status.

Figure 2

A) Kaplan-Meier curves for sputum culture conversion for HIV-positive (dashed line) and HIV-negative (solid line) patients with extensively drug-resistant tuberculosis (XDR TB) receiving treatment, KwaZulu-Natal Province, South Africa. Sputum culture conversion is defined as 2 consecutive monthly TB cultures with no growth after 6 weeks of incubation after initiation of treatment (p = 0.706). p value was adjusted for age, initial smear result, and HIV status. B) Kaplan-Meier curves for patients receiving treatment for XDR TB stratified by sputum culture conversion status (p<0.0001). Solid line indicates conversion ≤2 months after initiation of treatment, dashed line indicates conversion >2 months after initiation of treatment, and top line with small and large dashes indicates no conversion. p values were adjusted for sex, TB treatment history, and HIV status. There was no significant difference between patients who showed culture conversion <2 months and >2 months after initiation of treatment (p = 0.5182).