       Document 0994
 DOCN  M9650994
 TI    Predictors and outcome of multidrug-resistant tuberculosis.
 DT    9505
 AU    Salomon N; Perlman DC; Friedmann P; Buchstein S; Kreiswirth BN; Mildvan
       D; Department of Medicine, Beth Israel Medical Center, New York, New;
       York 10003, USA.
 SO    Clin Infect Dis. 1995 Nov;21(5):1245-52. Unique Identifier : AIDSLINE
       MED/96126011
 AB    We identify early predictors of multidrug-resistant tuberculosis and
       describe improved clinical outcomes, including survival, for patients
       with human immunodeficiency virus (HIV)-related multidrug-resistant
       tuberculosis (MDR-TB) when they are prospectively identified and receive
       treatment under direct observation. Analysis by means of a Cox
       proportional hazards model revealed that failure to defervesce while
       receiving a standard four-drug antituberculous regimen was independently
       associated with multidrug resistance (P = .004). When patients with
       HIV-related MDR-TB were prospectively identified and treated with at
       least two agents that were active in vitro, 100% bacteriologic
       conversion and improved survival (> or = 4 months for 88% of patients
       and > or = 1 year for 59% of patients) were observed. For patients with
       HIV-related tuberculosis, poorer survival was associated with a CD4+
       lymphocyte count of < 25 mm3 (P = .03); multidrug resistance was not a
       predictor of poor outcome (P = .82). These data suggest that patients
       with prolonged fever who are receiving antituberculous therapy may be an
       appropriate subgroup to target for broader empirical therapy. The
       findings also demonstrate that improved outcomes can be achieved with
       HIV-related MDR-TB when patients are prospectively identified and
       treated with agents that are active in vitro.
 DE    Adult  Antitubercular Agents/*THERAPEUTIC USE  AIDS-Related
       Opportunistic Infections/*COMPLICATIONS/*DRUG  THERAPY/MICROBIOLOGY
       Cohort Studies  Drug Resistance, Multiple/GENETICS  Female
       Fever/COMPLICATIONS/DRUG THERAPY  Human  Male  Middle Age  Mycobacterium
       tuberculosis/DRUG EFFECTS/GENETICS  Polymorphism, Restriction Fragment
       Length  Proportional Hazards Models  Prospective Studies  Support,
       Non-U.S. Gov't  Survival Analysis  Treatment Outcome  Tuberculosis,
       Multidrug-Resistant/*COMPLICATIONS/*DRUG THERAPY/  MICROBIOLOGY  JOURNAL
       ARTICLE

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

