Survival from XDR-TB is associated with modifiable clinical characteristics in rural South Africa

• Published in: PloS one 2012-03, Vol.7 (3), p.e31786
• Main Authors: Shenoi, Sheela V, Brooks, Ralph P, Barbour, Russell, Altice, Frederick L, Zelterman, Daniel, Moll, Anthony P, Master, Iqbal, van der Merwe, Theo L, Friedland, Gerald H
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Air bases; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; Antitubercular Agents - therapeutic use; Case-Control Studies; CD4 antigen; Coinfection - drug therapy; Coinfection - mortality; Comorbidity; Concurrent infection; Diagnostic systems; Drug resistance; Extensively Drug-Resistant Tuberculosis - drug therapy; Extensively Drug-Resistant Tuberculosis - mortality; Female; Health aspects; Health risks; Highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; HIV Infections - mortality; HIV patients; Human immunodeficiency virus; Humans; Kaplan-Meier Estimate; Male; Medical diagnosis; Medical research; Medicine; Microbial drug resistance; Middle Aged; Mortality; Patients; Public health; Retrospective Studies; Risk analysis; Risk Factors; Risk management; Rural communities; Smear; South Africa; Sputum; Survival; Therapy; Tuberculosis
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0031786

Drug-resistant tuberculosis (TB) is a major threat to global public health. Patients with extensively drug-resistant TB (XDR-TB), particularly those with HIV-coinfection, experience high and accelerated mortality with limited available interventions. To determine modifiable factors associated with survival, we evaluated XDR-TB patients from a community-based hospital in rural South Africa where a large number of XDR-TB cases were first detected. A retrospective case control study was conducted of XDR-TB patients diagnosed from 2005-2008. Survivors, those alive at 180 days from diagnostic sputum collection date, were compared with controls who died within 180 days. Clinical, laboratory and microbiological correlates of survival were assessed in 69 survivors (median survival 565 days [IQR 384-774] and 73 non-survivors (median survival 34 days [IQR 18-90]). Among 129 HIV+ patients, multivariate analyses of modifiable factors demonstrated that negative AFB smear (AOR 8.4, CI 1.84-38.21), a lower laboratory index of routine laboratory findings (AOR 0.48, CI 0.22-1.02), CD4>200 cells/mm(3) (AOR 11.53, 1.1-119.32), and receipt of antiretroviral therapy (AOR 20.9, CI 1.16-376.83) were independently associated with survival from XDR-TB. Survival from XDR-TB with HIV-coinfection is associated with less advanced stages of both diseases at time of diagnosis, absence of laboratory markers indicative of multiorgan dysfunction, and provision of antiretroviral therapy. Survival can be increased by addressing these modifiable risk factors through policy changes and improved clinical management. Health planners and clinicians should develop programmes focusing on earlier case finding and integration of HIV and drug-resistant TB diagnostic, therapeutic, and preventive activities.