Outcomes of Multi-Drug Resistant Tuberculosis (MDR-TB) among a Cohort of South African Patients with High HIV Prevalence 英文参考文献.docVIP

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Outcomes of Multi-Drug Resistant Tuberculosis (MDR-TB) among a Cohort of South African Patients with High HIV Prevalence 英文参考文献.doc

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Outcomes of Multi-Drug Resistant Tuberculosis (MDR-TB) among a Cohort of South African Patients with High HIV Prevalence 英文参考文献

OutcomesofMulti-DrugResistantTuberculosis(MDR-TB) amongaCohortofSouthAfricanPatientswithHighHIV Prevalence JasonE.Farley1*,MalathiRam2,WilliamPan2,StacieWaldman5,GailH.Cassell5,RichardE.Chaisson2,3,4, KarinWeyer6,JoeyLancaster6,MartieVanderWalt6 1JohnsHopkinsUniversitySchoolofNursing,Baltimore,Maryland,UnitedStatesofAmerica,2BloombergSchoolofPublicHealth,Baltimore,Maryland,UnitedStatesof America,3SchoolofMedicine,Baltimore,Maryland,UnitedStatesofAmerica,4CenterforTuberculosisResearch,Baltimore,Maryland,UnitedStatesofAmerica,5EliLilly and Company, Indianapolis, Indiana, United States of America, 6South African Medical Research Council, Tuberculosis Epidemiology and Intervention Research Unit, Pretoria,SouthAfrica Abstract Background: Multidrug-resistant tuberculosis (MDR-TB) is a major clinical challenge, particularly in patients with human immunodeficiencyvirus(HIV)co-infection.MDR-TBtreatmentisincreasinglyavailable,butoutcomeshavenotbeenwell characterized. South Africa has provided MDR-TB treatment for a decade, andwe evaluated outcomes by HIV status for patientsenrolledbetween2000and2004priortoanti-retroviralaccess. Methods:WeassessedtreatmentoutcomesinaprospectivecohortofpatientswithMDR-TBfromeightprovincialprograms providingsecondlinedrugs.WorldHealthOrganizationdefinitionswereused.ResultswerestratifiedbyHIVstatus. Results:SevenhundredfiftysevenpatientswithknownHIVstatuswereincludedinthefinalanalysis,andHIVinfectionwas documentedin287(38%).Overall,348patients(46.0%)weresuccessfullytreated,74(9.8%)failedtherapy,177(23.4%)died and158(20.9%)defaulted.PatientswithHIVwereslightlyyoungerandlesslikelytobemalecomparedtoHIVnegative patients.PatientswithHIVwerelesslikelytohaveasuccessfultreatmentoutcome(40.0vs.49.6;P,0.05)andmorelikelyto die(35.2vs.16.2;P,0.0001).Inacompetingrisksurvivalanalysis,patientswithHIVhadahigherhazardofdeath(HR:2.33, P,0.0001).Lowbaselineweight(lessthan45kgandlessthan60kg)wasalsoassociatedwithahigherhazardofdeath(HR: 2.52,P,0.0001;andHR:1.50,P,