{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T09:17:36Z","timestamp":1776763056031,"version":"3.51.2"},"reference-count":40,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,5,24]],"date-time":"2022-05-24T00:00:00Z","timestamp":1653350400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001713","name":"European and Developing Countries Clinical Trials Partnership","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001322","name":"South African Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We compared mortality between HIV\u2010positive and HIV\u2010negative South African adults with drug\u2010resistant tuberculosis (DR\u2010TB) and high incidence of acquired second\u2010line drug resistance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective review of DR\u2010TB patients with serial second\u2010line TB drug susceptibility tests (2008\u20132015) who were hospitalized at a specialized TB hospital. We used Kaplan\u2013Meier analysis and Cox models to examine associations with mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 245 patients, the median age was 33\u2009years, 54% were male and 40% were HIV\u2010positive, 96% of whom had ever received antiretroviral therapy (ART). At initial drug resistance detection, 99% of patients had resistance to at least rifampicin and isoniazid, and 18% had second\u2010line drug resistance (fluoroquinolones and\/or injectable drugs). At later testing, 88% of patients had acquired additional second\u2010line drug resistance. Patient\u2010initiated treatment interruptions (&gt;\u20092\u2009months) occurred in 47%. Mortality was 79%. Those with HIV had a shorter time to death (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.02; log\u2010rank): median survival time from DR\u2010TB treatment initiation was 2.44\u2009years [95% confidence interval (CI): 2.09\u20133.15] versus 3.99\u2009years (95% CI: 3.12\u20134.75) for HIV\u2010negative patients. HIV\u2010positive patients who received ART within 6\u00a0months before DR\u2010TB treatment had a higher mortality hazard than HIV\u2010negative patients [adjusted hazard ratio (aHR) ratio\u00a0=\u00a01.82, 95% CI: 1.21\u20132.74]. By contrast, HIV\u2010positive patients who did not receive ART within 6\u00a0months before DR\u2010TB treatment did not have a significantly higher mortality hazard than HIV\u2010negative patients (aHR\u00a0=\u00a01.09; 95% CI: 0.72\u20131.65), although those on ART had lower median CD4 counts than those not on ART (157 vs. 281 cells\/\u03bcL, respectively; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A very high incidence of acquired second\u2010line drug resistance and high overall mortality were observed, reinforcing the need to reduce the risk of acquired resistance and for more effective treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.13318","type":"journal-article","created":{"date-parts":[[2022,5,24]],"date-time":"2022-05-24T09:10:30Z","timestamp":1653383430000},"page":"1085-1097","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["High mortality among patients hospitalized for drug\u2010resistant tuberculosis with acquired second\u2010line drug resistance and high <scp>HIV<\/scp> prevalence"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2453-6219","authenticated-orcid":false,"given":"Kim","family":"Anderson","sequence":"first","affiliation":[{"name":"Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute University of Cape Town  Cape Town South Africa"},{"name":"Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine University of Cape Town  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elize","family":"Pietersen","sequence":"additional","affiliation":[{"name":"Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute University of Cape Town  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan E.","family":"Shepherd","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University School of Medicine  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aihua","family":"Bian","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University School of Medicine  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keertan","family":"Dheda","sequence":"additional","affiliation":[{"name":"Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute University of Cape Town  Cape Town South Africa"},{"name":"South African MRC Centre for the Study of Antimicrobial Resistance University of Cape Town  Cape Town South Africa"},{"name":"Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robin","family":"Warren","sequence":"additional","affiliation":[{"name":"DST\u2010NRF Centre of Excellence for Biomedical Tuberculosis Research\/SAMRC Centre for TB Research\/Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences Stellenbosch University  Tygerberg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy R.","family":"Sterling","sequence":"additional","affiliation":[{"name":"Vanderbilt Tuberculosis Center Vanderbilt University School of Medicine  Nashville Tennessee USA"},{"name":"Division of Infectious Diseases, Department of Medicine Vanderbilt University School of Medicine  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuri F.","family":"van der Heijden","sequence":"additional","affiliation":[{"name":"Vanderbilt Tuberculosis Center Vanderbilt University School of Medicine  Nashville Tennessee USA"},{"name":"Division of Infectious Diseases, Department of Medicine Vanderbilt University School of Medicine  Nashville Tennessee USA"},{"name":"The Aurum Institute  Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,5,24]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"World Health Organization [Internet]. 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