• S B Mannheimer, K A Sepkowitz, M Stoeckle, C R Friedman, A Hafner, and L W Riley.
• Division of Infectious Diseases and International Medicine, Cornell University Medical College, New York, NY, USA. sbm20@columbia.edu
• Int. J. Tuberc. Lung Dis. 1997 Aug 1; 1 (4): 319-25.

SettingAn 880 bed university teaching hospital in New York City.ObjectiveTo assess risk factors and outcome for sporadic cases of multidrug-resistant tuberculosis (MDR-TB) in persons with human immunodeficiency virus (HIV) infection.DesignIn a retrospective cohort analysis, 13 HIV-positive patients with MDR-TB (cases) diagnosed between January 1991 and December 1993 were compared to 31 HIV-infected patients with susceptible or single drug-resistant tuberculosis (controls) diagnosed during the same time period to assess for differences in risk factors and outcome.ResultsRisk factors for MDR-TB included homosexual contact as a risk for HIV transmission, prior antiretroviral 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 associated with death included multidrug-resistance and CD4-lymphocyte counts below 200.ConclusionSporadic MDR-TB infection in HIV-infected patients is associated with increased morbidity and mortality compared to infection with susceptible or single-drug-resistant TB. The median survival for HIV-infected patients with MDR-TB in this study is, however, two to three times longer than previously reported in MDR-TB outbreaks.

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