Culture conversion among HIV co-infected multidrug-resistant tuberculosis patients in Tugela ferry, South Africa

James C.M. Brust, Melissa Lygizos, Krisda Chaiyachati, Michelle Scott, Theo L. van der Merwe, Anthony P. Moll, Xuan Li, Marian Loveday, Sheila A. Bamber, Umesh G. Lalloo, Gerald H. Friedland, N. Sarita Shah, Neel R. Gandhi

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article numbere15841
JournalPLoS One
Volume6
Issue number1
DOIs
StatePublished - 2011

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Multidrug-Resistant Tuberculosis
South Africa
tuberculosis
HIV
therapeutics
Therapeutics
Sputum
CD4 Lymphocyte Count
Coinfection
mixed infection
drug therapy
HIV Infections

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Brust, J. C. M., Lygizos, M., Chaiyachati, K., Scott, M., van der Merwe, T. L., Moll, A. P., ... Gandhi, N. R. (2011). Culture conversion among HIV co-infected multidrug-resistant tuberculosis patients in Tugela ferry, South Africa. PLoS One, 6(1), [e15841]. https://doi.org/10.1371/journal.pone.0015841

Culture conversion among HIV co-infected multidrug-resistant tuberculosis patients in Tugela ferry, South Africa. / Brust, James C.M.; Lygizos, Melissa; Chaiyachati, Krisda; Scott, Michelle; van der Merwe, Theo L.; Moll, Anthony P.; Li, Xuan; Loveday, Marian; Bamber, Sheila A.; Lalloo, Umesh G.; Friedland, Gerald H.; Sarita Shah, N.; Gandhi, Neel R.

In: PLoS One, Vol. 6, No. 1, e15841, 2011.

Research output: Contribution to journalArticle

Brust, JCM, Lygizos, M, Chaiyachati, K, Scott, M, van der Merwe, TL, Moll, AP, Li, X, Loveday, M, Bamber, SA, Lalloo, UG, Friedland, GH, Sarita Shah, N & Gandhi, NR 2011, 'Culture conversion among HIV co-infected multidrug-resistant tuberculosis patients in Tugela ferry, South Africa', PLoS One, vol. 6, no. 1, e15841. https://doi.org/10.1371/journal.pone.0015841
Brust, James C.M. ; Lygizos, Melissa ; Chaiyachati, Krisda ; Scott, Michelle ; van der Merwe, Theo L. ; Moll, Anthony P. ; Li, Xuan ; Loveday, Marian ; Bamber, Sheila A. ; Lalloo, Umesh G. ; Friedland, Gerald H. ; Sarita Shah, N. ; Gandhi, Neel R. / Culture conversion among HIV co-infected multidrug-resistant tuberculosis patients in Tugela ferry, South Africa. In: PLoS One. 2011 ; Vol. 6, No. 1.
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abstract = "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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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.

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AU - Gandhi, Neel R.

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