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TUBERCULOSIS MORTALITY, DRUG RESISTANCE, AND INFECTIOUSNESS IN PATIENTS WITH AND WITHOUT HIV INFECTION IN PERU

2006; American Society of Tropical Medicine and Hygiene; Volume: 75; Issue: 6 Linguagem: Inglês

10.4269/ajtmh.2006.75.1027

1476-1645

Vivian Kawai, Richard Rodríguez, Carlton A. Evans, Christian T. Bautista, A. Roderick Escombe, Robert H. Gilman, Eduardo Ticona, Víctor Chávez, Marco Tovar, Giselle Soto, Jaime Ortiz, Luz Huaroto, Luz Caviedes,

Pneumonia and Respiratory Infections

The effects of HIV co-infection and multi-drug resistant tuberculosis (MDRTB) on tuberculosis prognosis are poorly defined. Therefore, we studied infectiousness and mortality of 287 tuberculosis patients treated with standard, directly observed, short-course therapy in the Peruvian community. During 6–17 months of treatment, 49 (18%) of patients died, of whom 48 (98%) had AIDS and 28 (57%) had MDRTB; 17/31 (55%) of MDRTB-patients with AIDS died within 2 months of diagnosis, before traditional susceptibility testing would have identified their MDRTB. Most non-MDRTB became smear- and culture-negative within 6 weeks of therapy, whereas most MDRTB remained sputum-culture-positive until death or treatment completion. HIV-negative patients with non-MDRTB had good outcomes. However, MDRTB was associated with prolonged infectiousness and HIV co-infection with early mortality, indicating a need for greater access to anti-retroviral therapy. Furthermore, early and rapid tuberculosis drug-susceptibility testing and infection control are required so that MDRTB can be appropriately treated early enough to reduce mortality and transmission.