O'Donnell Max R, Padayatchi N, Master I, Osburn G, Horsburgh C R
Section of Pulmonary, Allergy, and Critical Care Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
Int J Tuberc Lung Dis. 2009 Jul;13(7):855-61.
A public tuberculosis (TB) referral hospital in KwaZulu-Natal, South Africa.
To present treatment outcomes of patients with extensively drug-resistant tuberculosis (XDR-TB) patients and human immunodeficiency virus (HIV) coinfection with and without highly active antiretroviral therapy.
Retrospective cohort study. Eligible patients had drug susceptibility testing that met a consensus definition for XDR-TB, and agreed to treatment. Therapy was based on drug susceptibilities, available medications and patient tolerance.
Overall, 60 XDR-TB patients initiated therapy with a median number of 5.5 drugs. Of these, 43 (72%) were HIV-positive, and 21 (49%) were on antiretroviral therapy; 29 HIV-infected patients (67%) had available CD4 counts, with a median CD4 count of 200.5 cells/mm(3) (standard deviation 127.4 cells/mm(3)). Of 60 patients, 31 (52%) had adverse events (AEs), and 17/60 patients (28%) had severe AEs. During follow-up, 12/60 (20%) experienced sputum culture conversion, while 25/60 (42%) patients died. None of the following was significantly associated with mortality: HIV status, previous MDR diagnosis or severe AEs.
In this study, it was possible to treat HIV-XDR-TB coinfected patients and prolong survival in a resource-limited setting. We highlight the challenges in treatment, including high frequencies of AEs and death. Expanded identification of cases, prompt referral for treatment, and attention to management of comorbidities may facilitate successful treatment of XDR-TB in HIV-infected patients.
南非夸祖鲁 - 纳塔尔省的一家公共结核病转诊医院。
介绍广泛耐药结核病（XDR - TB）患者合并或未合并人类免疫缺陷病毒（HIV）感染且接受或未接受高效抗逆转录病毒治疗的治疗结果。
回顾性队列研究。符合条件的患者进行了药敏试验，该试验符合XDR - TB的共识定义，并同意接受治疗。治疗基于药敏结果、可用药物和患者耐受性。
总体而言，60例XDR - TB患者开始治疗，平均使用5.5种药物。其中，43例（72%）为HIV阳性，21例（49%）接受抗逆转录病毒治疗；29例HIV感染患者（67%）有可用的CD4细胞计数，CD4细胞计数中位数为200.5个细胞/mm³（标准差127.4个细胞/mm³）。60例患者中，31例（52%）发生不良事件（AE），17/60例患者（28%）发生严重AE。在随访期间，12/60例（20%）痰培养转阴，而25/60例（42%）患者死亡。以下因素均与死亡率无显著相关性：HIV状态、既往耐多药诊断或严重AE。
在本研究中，在资源有限的环境中治疗HIV - XDR - TB合并感染患者并延长生存期是可行的。我们强调了治疗中的挑战，包括AE和死亡的高发生率。扩大病例识别、及时转诊治疗以及关注合并症的管理可能有助于成功治疗HIV感染患者的XDR - TB。
