early outcomes of mdr-tb treatment in a high hiv-prevalence setting in southern africa耐多药结核病治疗艾滋病毒感染率高的早期结果设置在非洲南部.pdfVIP

Early Outcomes of MDR-TB Treatment in a High HIV- Prevalence Setting in Southern Africa 1 2 1 1 1 Kwonjune J. Seung *, David B. Omatayo , Salmaan Keshavjee , Jennifer J. Furin , Paul E. Farmer , Hind Satti2 1 Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America, 2 Partners In Health, Lesotho, Maseru, Lesotho Abstract Background: Little is known about treatment of multidrug-resistant tuberculosis (MDR-TB) in high HIV-prevalence settings such as sub-Saharan Africa. Methodology/Principal Findings: We did a retrospective analysis of early outcomes of the first cohort of patients registered in the Lesotho national MDR-TB program between July 21, 2007 and April 21, 2008. Seventy-six patients were included for analysis. Patient follow-up ended when an outcome was recorded, or on October 21, 2008 for those still on treatment. Fifty- six patients (74%) were infected with HIV; the median CD4 cell count was 184 cells/ml (range 5–824 cells/ml). By the end of the follow-up period, study patients had been followed for a median of 252 days (range 12–451 days). Twenty-two patients (29%) had died, and 52 patients (68%) were alive and in treatment. In patients who did not die, culture conversion was documented in 52/54 patients (96%). One patient had defaulted, and one patient had transferred out. Death occurred after a median of 66 days in treatment (range 12–374 days). Conclusions/Significance: In a region where clinicians and program managers are increasingly confronted by drug-resistant tuberculosis, this report provides sobering evidence of the difficulty of MDR-TB treatment in high HIV-prevalence settings. In Lesotho, an innovative community-based treatment model that involved social and