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

Neel R. Gandhi, J. R. Andrews, James C.M. Brust, R. Montreuil, D. Weissman, Moonseong Heo, A. P. Moll, G. H. Friedland, N. S. Shah

Research output: Contribution to journalArticle

51 Citations (Scopus)

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/mm 3 (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.

Original languageEnglish (US)
Pages (from-to)90-97
Number of pages8
JournalInternational Journal of Tuberculosis and Lung Disease
Volume16
Issue number1
DOIs
StatePublished - Jan 2012

Fingerprint

Multidrug-Resistant Tuberculosis
HIV
Mortality
Tuberculosis
CD4 Lymphocyte Count
Extensively Drug-Resistant Tuberculosis
Africa South of the Sahara
Virus Diseases
South Africa
Coinfection
Drug Resistance
Immunosuppression
Case-Control Studies
Therapeutics
Cross-Sectional Studies
Pharmaceutical Preparations

Keywords

  • MDR-TB
  • Mortality
  • Risk factors
  • TB-HIV co-infection
  • XDR-TB

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

Cite this

Risk factors for mortality among MDR- and XDR-TB patients in a high HIV prevalence setting. / Gandhi, Neel R.; Andrews, J. R.; Brust, James C.M.; Montreuil, R.; Weissman, D.; Heo, Moonseong; Moll, A. P.; Friedland, G. H.; Shah, N. S.

In: International Journal of Tuberculosis and Lung Disease, Vol. 16, No. 1, 01.2012, p. 90-97.

Research output: Contribution to journalArticle

Gandhi, NR, Andrews, JR, Brust, JCM, Montreuil, R, Weissman, D, Heo, M, Moll, AP, Friedland, GH & Shah, NS 2012, 'Risk factors for mortality among MDR- and XDR-TB patients in a high HIV prevalence setting', International Journal of Tuberculosis and Lung Disease, vol. 16, no. 1, pp. 90-97. https://doi.org/10.5588/ijtld.11.0153
Gandhi, Neel R. ; Andrews, J. R. ; Brust, James C.M. ; Montreuil, R. ; Weissman, D. ; Heo, Moonseong ; Moll, A. P. ; Friedland, G. H. ; Shah, N. S. / Risk factors for mortality among MDR- and XDR-TB patients in a high HIV prevalence setting. In: International Journal of Tuberculosis and Lung Disease. 2012 ; Vol. 16, No. 1. pp. 90-97.
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