       Document 0113
 DOCN  M9640113
 TI    Outcome of MDR-TB patients, 1983-1993. Prolonged survival with
       appropriate therapy.
 DT    9604
 AU    Park MM; Davis AL; Schluger NW; Cohen H; Rom WN; Department of Medicine,
       New York University Medical Center, New; York, USA.
 SO    Am J Respir Crit Care Med. 1996 Jan;153(1):317-24. Unique Identifier :
       AIDSLINE MED/96134240
 AB    We analyzed the clinical and laboratory findings and outcome of 173
       patients hospitalized at our institution from 1983 to 1994 with
       multidrug-resistant tuberculosis (MDR-TB) and evaluated outcome. The 173
       patients (mean age 40 +/- 1 yr) were predominantly male (92%), African
       American or Hispanic (80%), and mostly undomiciled. Over half (52%) were
       known to be HIV-infected. HIV-positive MDR-TB patients had significantly
       more pulmonary and constitutional symptoms, more extrapulmonary disease,
       and fewer cavitary lesions on chest radiographs. Fifty-five percent of
       the patients in the cohort have died; mortality was significantly
       greater for HIV-positive than HIV-negative (72% versus 20%, p < 0.01).
       The median duration of survival of MDR-TB patients was 22 +/- 1 mo.
       Overall, extrapulmonary involvement was a risk factor for shorter
       survival, while a cavitary lesion on initial chest film and institution
       of appropriate treatment were positive predictors of survival. In HIV+
       patients, only appropriate therapy was associated with prolonged
       survival (median of 14.1 mo). Interestingly, there was a trend toward
       better outcome in the first half of the decade reviewed. We conclude
       that although mortality from MDR-TB is high in both HIV-positive and
       HIV-negative patients, institution of appropriate therapy is the factor
       most strongly associated with a favorable outcome. Development of new
       diagnostic and therapeutic strategies for MDR-TB are urgently needed.
 DE    Acquired Immunodeficiency Syndrome/COMPLICATIONS/MORTALITY  Adult  Cause
       of Death  Comparative Study  Female  Human  HIV
       Infections/COMPLICATIONS/MORTALITY  HIV Seronegativity  HIV
       Seropositivity/COMPLICATIONS/MORTALITY  Male  Middle Age  Retrospective
       Studies  Risk Factors  Support, Non-U.S. Gov't  Support, U.S. Gov't,
       Non-P.H.S.  Support, U.S. Gov't, P.H.S.  Survival Analysis  Time Factors
       Tuberculosis, Multidrug-Resistant/COMPLICATIONS/*MORTALITY/  THERAPY
       JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

