TY - JOUR
T1 - Culture conversion among HIV co-infected multidrug-resistant tuberculosis patients in Tugela ferry, South Africa
AU - Brust, James C.M.
AU - Lygizos, Melissa
AU - Chaiyachati, Krisda
AU - Scott, Michelle
AU - van der Merwe, Theo L.
AU - Moll, Anthony P.
AU - Li, Xuan
AU - Loveday, Marian
AU - Bamber, Sheila A.
AU - Lalloo, Umesh G.
AU - Friedland, Gerald H.
AU - Sarita Shah, N.
AU - Gandhi, Neel R.
N1 - Funding Information:
U.G.L. has no competing interests with respect to this study. He has consulted for GlaxoSmithKline, Boehringer Ingelheim, Merck Sharp and Dohme, and AstraZeneca) and has received financial support from these companies to attend research conferences. The current study, however, was not funded by these or any other pharmaceutical or device companies. None of the companies listed were involved in any part of the study's design, execution, or analysis and Dr. Lalloo's relationship with the listed companies does not affect the authors' adherence to any of PLoS One's policies on sharing data and materials. None of the other authors has any competing or potentially competing interests.
PY - 2011
Y1 - 2011
N2 - Background: Little is known about the time to sputum culture conversion in MDR-TB patients co-infected with HIV, although such patients have, historically, had poor outcomes. We describe culture conversion rates among MDR-TB patients with and without HIV-co-infection in a TB-endemic, high-HIV prevalent, resource-limited setting. Methods: Patients with culture-proven MDR-TB were treated with a standardized second-line regimen. Sputum cultures were taken monthly and conversion was defined as two negative cultures taken at least one month apart. Time-toconversion was measured from the day of initiation of MDR-TB therapy. Subjects with HIV received antiretroviral therapy (ART) regardless of CD4 count. Results: Among 45 MDR-TB patients, 36 (80%) were HIV-co-infected. Overall, 40 (89%) of the 45 patients culture-converted within the first six months and there was no difference in the proportion who converted based on HIV status. Median timetconversion was 62 days (IQR 48-111). Among the five patients who did not culture convert, three died, one was transferred to another facility, and one refused further treatment before completing 6 months of therapy. Thus, no patients remained persistently culture-positive at 6 months of therapy. Conclusions: With concurrent second-line TB and ART medications, MDR-TB/HIV co-infected patients can achieve culture conversion rates and times similar to those reported from HIV-negative patients worldwide. Future studies are needed to examine whether similar cure rates are achieved at the end of MDR-TB treatment and to determine the optimal use and timing of ART in the setting of MDR-TB treatment.
AB - Background: Little is known about the time to sputum culture conversion in MDR-TB patients co-infected with HIV, although such patients have, historically, had poor outcomes. We describe culture conversion rates among MDR-TB patients with and without HIV-co-infection in a TB-endemic, high-HIV prevalent, resource-limited setting. Methods: Patients with culture-proven MDR-TB were treated with a standardized second-line regimen. Sputum cultures were taken monthly and conversion was defined as two negative cultures taken at least one month apart. Time-toconversion was measured from the day of initiation of MDR-TB therapy. Subjects with HIV received antiretroviral therapy (ART) regardless of CD4 count. Results: Among 45 MDR-TB patients, 36 (80%) were HIV-co-infected. Overall, 40 (89%) of the 45 patients culture-converted within the first six months and there was no difference in the proportion who converted based on HIV status. Median timetconversion was 62 days (IQR 48-111). Among the five patients who did not culture convert, three died, one was transferred to another facility, and one refused further treatment before completing 6 months of therapy. Thus, no patients remained persistently culture-positive at 6 months of therapy. Conclusions: With concurrent second-line TB and ART medications, MDR-TB/HIV co-infected patients can achieve culture conversion rates and times similar to those reported from HIV-negative patients worldwide. Future studies are needed to examine whether similar cure rates are achieved at the end of MDR-TB treatment and to determine the optimal use and timing of ART in the setting of MDR-TB treatment.
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U2 - 10.1371/journal.pone.0015841
DO - 10.1371/journal.pone.0015841
M3 - Article
C2 - 21253585
AN - SCOPUS:79251562482
SN - 1932-6203
VL - 6
JO - PloS one
JF - PloS one
IS - 1
M1 - e15841
ER -