Extensively drug-resistant tuberculosis in South Africa

[kkmalaysia]

Extensively drug-resistant (XDR) tuber­culosis (resistant to at least rifamipicin, isoniazid, a fluoroquinolone, and at least one second-line injectable drug such as amikacin, kanamycin, or capreomycin) has been reported from nine countries.

Reports of treatment success rates have varied. In Peru, more than half of patients with XDR tuberculosis were cured or completed treatment. In KwaZulu Natal, South Africa, almost all patients with XDR tuberculosis had HIV infection and died. Now, a retrospective cohort study from four provincial treatment facilities in South Africa has been reported.

The study included 195 patients with XDR tuberculosis between August 2002 and February 2008. Twenty-one of these patients died before treatment. Of the remaining 174 patients, 82 (47%) had HIV infection and 62 (36%) died during follow-up. Mortality was not significantly different with or without HIV infection (41% vs 30%). Treatment with moxifloxacin and with multiple drugs were both signifi­cantly associated with reduced mortality and previous proved multidrug-resistant (MDR) tuberculosis was associated with a five-fold increase in mortality. Highly active antiretroviral therapy reduced mortality among patients with HIV infection. Mycobacterial cultures converted to negative in 33 patients (19%), of whom 23 converted within 6 months of starting antituberculosis treatment.

More than half of the patients in this study did not have HIV infection. Survival among patients with HIV infection was better than previously reported. National aims continue to be the prevention of XDR tuberculosis and early detection and treatment of XDR and MDR tuberculosis.

Source: Medical Progress