RISK-FACTORS AND OUTCOME OF HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS WITH SPORADIC MULTIDRUG-RESISTANT TUBERCULOSIS IN NEW-YORK-CITY

SETTING: An 880 bed university teaching hospital in New York City. OBJ ECTIVE: To assess risk factors and outcome for sporadic cases of multi drug-resistant tuberculosis (MDR-TB) in persons with human immunodefic iency virus (HIV) infection. DESIGN: In a retrospective cohort analysi s, 13 HIV-positive patients with MDR-TB (cases) diagnosed between Janu ary 1991 and December 1993 were compared to 31 HIV-infected patients w ith susceptible or single drug-resistant tuberculosis (controls) diagn osed during the same time period to assess for differences in risk fac tors and outcome. RESULTS: Risk factors for MDR-TB included homosexual contact as a risk for HIV transmission, prior anti-retroviral therapy and Pneumocystis carinii prophylaxis. Fatality rates were 62% for MDR -TB patients and 26% for controls (P < 0.04). The median survival time was 5.8 months for cases and 9.8 months for controls. Risk factors as sociated with death included multidrug-resistance and CD4-lymphocyte c ounts below 200. CONCLUSION: Sporadic MDR-TB infection in HIV-infected patients is associated with increased morbidity and mortality compare d to infection with susceptible or single-drug-resistant TB. The media n survival for HIV-infected patients with MDR-TB in this study is, how ever, two to three times longer than previously reported in MDR-TB out breaks.