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Survival from XDR-TB Is Associated with Modifiable Clinical Characteristics in Rural South Africa

BACKGROUND: 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 assoc...

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Autores principales: 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.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295798/
https://www.ncbi.nlm.nih.gov/pubmed/22412840
http://dx.doi.org/10.1371/journal.pone.0031786
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author 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.
author_facet 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.
author_sort Shenoi, Sheela V.
collection PubMed
description BACKGROUND: 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. METHODOLOGY/PRINCIPAL FINDINGS: 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. CONCLUSIONS/SIGNIFICANCE: 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.
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spelling pubmed-32957982012-03-12 Survival from XDR-TB Is Associated with Modifiable Clinical Characteristics in Rural South Africa 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. PLoS One Research Article BACKGROUND: 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. METHODOLOGY/PRINCIPAL FINDINGS: 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. CONCLUSIONS/SIGNIFICANCE: 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. Public Library of Science 2012-03-06 /pmc/articles/PMC3295798/ /pubmed/22412840 http://dx.doi.org/10.1371/journal.pone.0031786 Text en Shenoi et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
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.
Survival from XDR-TB Is Associated with Modifiable Clinical Characteristics in Rural South Africa
title Survival from XDR-TB Is Associated with Modifiable Clinical Characteristics in Rural South Africa
title_full Survival from XDR-TB Is Associated with Modifiable Clinical Characteristics in Rural South Africa
title_fullStr Survival from XDR-TB Is Associated with Modifiable Clinical Characteristics in Rural South Africa
title_full_unstemmed Survival from XDR-TB Is Associated with Modifiable Clinical Characteristics in Rural South Africa
title_short Survival from XDR-TB Is Associated with Modifiable Clinical Characteristics in Rural South Africa
title_sort survival from xdr-tb is associated with modifiable clinical characteristics in rural south africa
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295798/
https://www.ncbi.nlm.nih.gov/pubmed/22412840
http://dx.doi.org/10.1371/journal.pone.0031786
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