Recent studies suggest that the prevalence of drug-resistant TB in sub-Saharan Africa may be rising. This is of concern since HIV co-infection in MDR- and XDR-TB has been associated with exceedingly rates of mortality.
To identify risk factors associated with mortality in MDR- and XDR-TB patients co-infected with HIV in South Africa.
Case-control study of patients who died of all causes within two years of diagnosis with MDR- or XDR-TB.
Among 123 MDR-TB patients, 78 (63%) died following diagnosis. CD4 count less than 50 (HR 4.64, p=0.01) and 51-200 cells/mm3 (HR 4.17, p=0.008) were the strongest independent risk factors for mortality. Among 139 XDR-TB patients, 111 (80%) died. CD4 count less than 50 cells/mm3 (HR 4.46, p=0.01) and resistance to all six drugs tested (HR 2.54, p=0.04) were the principal risk factors. Use of antiretroviral therapy (ART) was protective (HR 0.34, p=0.009).
Mortality in MDR- and XDR-TB was associated with greater degree of immunosuppression and drug resistance. Efforts to reduce mortality must focus on preventing the amplification of resistance by strengthening TB treatment programs, as well as, reducing the pool of immunosuppressed HIV-infected patients through aggressive HIV testing and ART initiation.