Culture Conversion Among HIV Co-Infected Multidrug-Resistant Tuberculosis Patients in Tugela Ferry, South Africa

Abstract

BackgroundLittle is known about the time to sputum culture conversion in MDR-TB patients co-infected with HIV, although such patients have, historically, had poor outcomes. We describe culture conversion rates among MDR-TB patients with and without HIV-co-infection in a TB-endemic, high-HIV prevalent, resource-limited setting.MethodsPatients with culture-proven MDR-TB were treated with a standardized second-line regimen. Sputum cultures were taken monthly and conversion was defined as two negative cultures taken at least one month apart. Time-to-conversion was measured from the day of initiation of MDR-TB therapy. Subjects with HIV received antiretroviral therapy (ART) regardless of CD4 count.ResultsAmong 45 MDR-TB patients, 36 (80%) were HIV-co-infected. Overall, 40 (89%) of the 45 patients culture-converted within the first six months and there was no difference in the proportion who converted based on HIV status. Median time-to-conversion was 62 days (IQR 48-111). Among the five patients who did not culture convert, three died, one was transferred to another facility, and one refused further treatment before completing 6 months of therapy. Thus, no patients remained persistently culture-positive at 6 months of therapy.ConclusionsWith concurrent second-line TB and ART medications, MDR-TB/HIV co-infected patients can achieve culture conversion rates and times similar to those reported from HIV-negative patients worldwide. Future studies are needed to examine whether similar cure rates are achieved at the end of MDR-TB treatment and to determine the optimal use and timing of ART in the setting of MDR-TB treatment.

Improved survival in multidrug-resistant tuberculosis patients receiving integrated tuberculosis and antiretroviral treatment in the SAPiT Trial

“…Extremely high rates of primary MDR-TB have been reported from specific parts of KwaZulu-Natal. (19, 20) A high proportion of MDR-TB patients in these areas with high rates of HIV co-infection had no prior history of tuberculosis treatment, in contrast to a recent multi-country study which showed that a history of previous tuberculosis was the strongest risk factor for MDR-TB. (21, 22) It is also important to note that eight patients in our study initially had confirmed drug susceptible tuberculosis and subsequently developed MDR-TB.…”

Time to Culture Conversion and Regimen Composition in Multidrug-Resistant Tuberculosis Treatment

“…High rates of culture conversion within the first six months of effective MDR-TB treatment have also been shown in the past [22]. One possible explanation for lower conversion rates later in treatment is that patients who did not convert in the first six months may have been sicker and less likely to experience conversion on any regimen.…”

A Time-to-Event Pharmacodynamic Model Describing Treatment Response in Patients with Pulmonary Tuberculosis Using Days to Positivity in Automated Liquid Mycobacterial Culture

“…The small number of patients with HIV infection may explain our failure to identify HIV infection as a significant covariate. However, other studies have also shown that HIV infection does not appear to have an effect on sputum conversion rates (28)(29)(30).…”