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dc.contributor.authorSatti, Hind Elkheir
dc.contributor.authorMcLaughlin, Megan M
dc.contributor.authorHedt-Gauthier, Bethany
dc.contributor.authorAtwood, Sidney S.
dc.contributor.authorOmotayo, David B.
dc.contributor.authorNtlamelle, Likhapha
dc.contributor.authorSeung, Kwonjune Justin
dc.date.accessioned2013-04-22T14:06:31Z
dc.date.issued2012
dc.identifier.citationSatti, Hind, Megan M. McLaughlin, Bethany Hedt-Gauthier, Sidney S. Atwood, David B. Omotayo, Likhapha Ntlamelle, and Kwonjune J. Seung. 2012. Outcomes of multidrug-resistant tuberculosis treatment with early initiation of antiretroviral therapy for HIV co-infected patients in Lesotho. PLoS ONE 7(10): e46943.en_US
dc.identifier.issn1932-6203en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:10579113
dc.description.abstractBackground: Although the importance of concurrent treatment for multidrug-resistant tuberculosis (MDR-TB) and HIV co-infection has been increasingly recognized, there have been few studies reporting outcomes of MDR-TB and HIV co-treatment. We report final outcomes of comprehensive, integrated MDR-TB and HIV treatment in Lesotho and examine factors associated with death or treatment failure. Methods: We reviewed clinical charts of all adult patients who initiated MDR-TB treatment in Lesotho between January 2008 and September 2009. We calculated hazard ratios (HR) and used multivariable Cox proportional hazards regression to identify predictors of poor outcomes. Results: Of 134 confirmed MDR-TB patients, 83 (62%) were cured or completed treatment, 46 (34%) died, 3 (2%) transferred, 1 (1%) defaulted, and 1 (1%) failed treatment. Treatment outcomes did not differ significantly by HIV status. Among the 94 (70%) patients with HIV co-infection, 53% were already on antiretroviral therapy (ART) before MDR-TB treatment initiation, and 43% started ART a median of 16 days after the start of the MDR-TB regimen. Among HIV co-infected patients who died, those who had not started ART before MDR-TB treatment had a shorter median time to death (80 days vs. 138 days, p = 0.065). In multivariable analysis, predictors of increased hazard of failure or death were low and severely low body mass index (HR 2.75, 95% confidence interval [CI] 1.27–5.93; HR 5.50, 95% CI 2.38–12.69), and a history of working in South Africa (HR 2.37, 95% CI 1.24–4.52). Conclusions: Favorable outcomes can be achieved in co-infected patients using a community-based treatment model when both MDR-TB and HIV disease are treated concurrently and treatment is initiated promptly.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pone.0046943en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480376/pdf/en_US
dash.licenseLAA
dc.subjectMedicineen_US
dc.subjectGlobal Healthen_US
dc.subjectInfectious Diseasesen_US
dc.subjectBacterial Diseasesen_US
dc.subjectTuberculosisen_US
dc.subjectMulti-Drug-Resistant Tuberculosisen_US
dc.subjectSexually Transmitted Diseasesen_US
dc.subjectAIDSen_US
dc.subjectTropical Diseases (Non-Neglected)en_US
dc.subjectViral Diseasesen_US
dc.subjectHIVen_US
dc.subjectHIV diagnosis and managementen_US
dc.subjectHIV epidemiologyen_US
dc.subjectNon-Clinical Medicineen_US
dc.subjectHealth Care Providersen_US
dc.subjectPublic Healthen_US
dc.subjectBehavioral and Social Aspects of Healthen_US
dc.titleOutcomes of Multidrug-Resistant Tuberculosis Treatment with Early Initiation of Antiretroviral Therapy for HIV Co-Infected Patients in Lesothoen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS ONEen_US
dash.depositing.authorSeung, Kwonjune Justin
dc.date.available2013-04-22T14:06:31Z
dc.identifier.doi10.1371/journal.pone.0046943*
dash.contributor.affiliatedSatti, Hind Elkheir
dash.contributor.affiliatedSeung, Kwonjune


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