OUTCOME OF MDR-TB PATIENTS, 1983-1993 - PROLONGED SURVIVAL WITH APPROPRIATE THERAPY

We analyzed the clinical and laboratory findings and outcome of 173 pa tients hospitalized at our institution from 1983 to 1994 with multidru g-resistant tuberculosis (MDR-TB) and evaluated outcome. The 173 patie nts (mean age 40 +/- 1 yr) were predominantly male (99%), African Amer ican or Hispanic (80%), and mostly undomiciled. Over half (52%) were k nown to be HIV-infected. HIV-positive MDR-TB patients had significantl y more pulmonary and constitutional symptoms, more extrapulmonary dise ase, and fewer cavitary lesions on chest radiographs. Fifty-five perce nt of the patients in the cohort have died; mortality was significantl y 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 sur vival, while a cavitary lesion on initial chest film and institution o f appropriate treatment were positive predictors of survival. In HIVpatients, only appropriate therapy was associated with prolonged survi val (median of 14.1 mo). Interestingly, there was a trend toward bette r outcome in the first half of the decade reviewed. We conclude that a lthough mortality from MDR-TB is high in both HIV-positive and HIV-neg ative patients, institution of appropriate therapy is the factor most strongly associated with a favorable outcome. Development of new and t herapeutic strategies for MDR-TB are urgently needed.