{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T22:42:28Z","timestamp":1791067348103,"version":"4.1.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2010,1,1]],"date-time":"2010-01-01T00:00:00Z","timestamp":1262304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2010,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>The multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) epidemics are rapidly expanding in South Africa. Our initial report of HIV-associated XDR TB in South Africa revealed rapid and near complete mortality. Lower mortality has been described in the literature, but few of these patients have been HIV coinfected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To characterize mortality from MDR and XDR TB in a setting with high HIV-coinfection rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational study among 654 MDR and XDR TB cases diagnosed in Tugela Ferry, South Africa, from 2005 to 2007. Demographics and HIV status were abstracted from available medical records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Survival was determined from the date of sputum collection until October 2008 and correlated with year of diagnosis and drug-susceptibility test results. From 2005 to 2007, 272 MDR TB and 382 XDR TB cases were diagnosed; HIV-coinfection rates were 90 and 98%, respectively. One-year mortality was 71% for MDR and 83% for XDR TB patients; 40% of MDR TB and 51% of XDR TB cases died within 30 days of sputum collection. One-year mortality among both MDR and XDR TB patients improved from 2005 to 2007; however, the majority of deaths still occurred within the first 30 days. One-year and 30-day mortality rates were worse with greater degree of drug resistance (P &amp;lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mortality from MDR and XDR TB in this high HIV-prevalence region is extraordinarily high, particularly within the first 30 days. Efforts to reduce mortality must focus on earlier diagnosis and early initiation of second-line TB and antiretroviral therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.200907-0989oc","type":"journal-article","created":{"date-parts":[[2009,10,15]],"date-time":"2009-10-15T20:59:40Z","timestamp":1255640380000},"page":"80-86","source":"Crossref","is-referenced-by-count":207,"title":["HIV Coinfection in Multidrug- and Extensively Drug-Resistant Tuberculosis Results in High Early Mortality"],"prefix":"10.1093","volume":"181","author":[{"given":"Neel R.","family":"Gandhi","sequence":"first","affiliation":[{"name":"Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. Sarita","family":"Shah","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason R.","family":"Andrews","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California, San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venanzio","family":"Vella","sequence":"additional","affiliation":[{"name":"Italian Cooperation, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony P.","family":"Moll","sequence":"additional","affiliation":[{"name":"Philanjalo & Church of Scotland Hospital, Tugela Ferry, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Scott","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren","family":"Weissman","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Marra","sequence":"additional","affiliation":[{"name":"Istituto Superiore di Sanita, KwaZulu-Natal Department of Health, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umesh G.","family":"Lalloo","sequence":"additional","affiliation":[{"name":"Enhancing Care Initiative KZN, University of KwaZulu-Natal, Durban, South Africa; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald H.","family":"Friedland","sequence":"additional","affiliation":[{"name":"Department of Medicine, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2010,1,1]]},"reference":[{"key":"2026032504273355900_BIB1","year":"2008"},{"key":"2026032504273355900_BIB2","first-page":"756","volume-title":"Int J Tuberc Lung Dis","year":"2008"},{"key":"2026032504273355900_BIB3","first-page":"S86","volume-title":"J Infect Dis","year":"2007"},{"key":"2026032504273355900_BIB4","first-page":"380","volume-title":"Emerg Infect Dis","year":"2007"},{"key":"2026032504273355900_BIB5","first-page":"623","volume-title":"Eur Respir J","year":"2007"},{"key":"2026032504273355900_BIB6","first-page":"2153","volume-title":"JAMA","year":"2008"},{"key":"2026032504273355900_BIB7","first-page":"657","volume-title":"N Engl J Med","year":"2008"},{"key":"2026032504273355900_BIB8","first-page":"1575","volume-title":"Lancet","year":"2006"},{"key":"2026032504273355900_BIB9","first-page":"1345","volume-title":"Emerg Infect Dis","year":"2008"},{"key":"2026032504273355900_BIB10","first-page":"153","volume-title":"Lancet Infect Dis","year":"2009"},{"key":"2026032504273355900_BIB11","first-page":"563","volume-title":"N Engl J Med","year":"2008"},{"key":"2026032504273355900_BIB12","first-page":"1290","volume-title":"Clin Infect Dis","year":"2007"},{"key":"2026032504273355900_BIB13","first-page":"1700","volume-title":"Emerg Infect Dis","year":"2008"},{"key":"2026032504273355900_BIB14","first-page":"1403","volume-title":"Lancet","year":"2008"},{"key":"2026032504273355900_BIB15","first-page":"45","volume-title":"Int J Tuberc Lung Dis","year":"2006"},{"key":"2026032504273355900_BIB16","first-page":"919","volume-title":"Int J Tuberc Lung Dis","year":"1998"},{"key":"2026032504273355900_BIB17","first-page":"1605","volume-title":"AIDS","year":"2006"},{"key":"2026032504273355900_BIB18","first-page":"143","volume-title":"AIDS","year":"2001"},{"key":"2026032504273355900_BIB19","first-page":"343","volume-title":"Trans R Soc Trop Med Hyg","year":"1998"},{"key":"2026032504273355900_BIB20","year":"2007"},{"key":"2026032504273355900_BIB21","first-page":"855","volume-title":"Int J Tuberc Lung Dis","year":"2009"},{"key":"2026032504273355900_BIB22","first-page":"1016","volume-title":"Am J Epidemiol","year":"2005"},{"key":"2026032504273355900_BIB23","year":"2009"},{"key":"2026032504273355900_BIB24","year":"2009"},{"key":"2026032504273355900_BIB25"},{"key":"2026032504273355900_BIB26","first-page":"1176","volume-title":"MMWR Morb Mortal Wkly Rep","year":"2006"},{"key":"2026032504273355900_BIB27","first-page":"1539","volume-title":"N Engl J Med","year":"2006"},{"key":"2026032504273355900_BIB28","first-page":"3699","volume-title":"J Clin Microbiol","year":"2005"},{"key":"2026032504273355900_BIB29","first-page":"787","volume-title":"Am J Respir Crit Care Med","year":"2008"},{"key":"2026032504273355900_BIB30","first-page":"636","volume-title":"N Engl J Med","year":"2008"},{"key":"2026032504273355900_BIB31","first-page":"1370","volume-title":"Int J Tuberc Lung Dis","year":"2008"},{"key":"2026032504273355900_BIB32","first-page":"11293","volume-title":"Proc Natl Acad Sci USA","year":"2008"},{"key":"2026032504273355900_BIB33","first-page":"1897","volume-title":"AIDS","year":"2008"},{"key":"2026032504273355900_BIB34","first-page":"37","volume-title":"J Acquir Immune Defic Syndr","year":"2009"},{"key":"2026032504273355900_BIB35","first-page":"1582","volume-title":"J Infect Dis","year":"2008"}],"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/181\/1\/80\/67506457\/ajrccm_181_1_80.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/181\/1\/80\/67506457\/ajrccm_181_1_80.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T08:32:08Z","timestamp":1774427528000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/article\/181\/1\/80\/8515385"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,1,1]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2010,1,1]]},"published-print":{"date-parts":[[2010,1,1]]}},"URL":"https:\/\/doi.org\/10.1164\/rccm.200907-0989oc","relation":{},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2010,1]]},"published":{"date-parts":[[2010,1,1]]}}}