Culture conversion among HIV co-infected multidrug-resistant tuberculosis patients in Tugela Ferry, South Africa

PLoS One. 2011 Jan 6;6(1):e15841. doi: 10.1371/journal.pone.0015841.


Background: Little is known about the time to sputum culture conversion in MDR-TB patients co-infected with HIV, although such patients have, historically, had poor outcomes. We describe culture conversion rates among MDR-TB patients with and without HIV-co-infection in a TB-endemic, high-HIV prevalent, resource-limited setting.

Methods: Patients with culture-proven MDR-TB were treated with a standardized second-line regimen. Sputum cultures were taken monthly and conversion was defined as two negative cultures taken at least one month apart. Time-to-conversion was measured from the day of initiation of MDR-TB therapy. Subjects with HIV received antiretroviral therapy (ART) regardless of CD4 count.

Results: Among 45 MDR-TB patients, 36 (80%) were HIV-co-infected. Overall, 40 (89%) of the 45 patients culture-converted within the first six months and there was no difference in the proportion who converted based on HIV status. Median time-to-conversion was 62 days (IQR 48-111). Among the five patients who did not culture convert, three died, one was transferred to another facility, and one refused further treatment before completing 6 months of therapy. Thus, no patients remained persistently culture-positive at 6 months of therapy.

Conclusions: With concurrent second-line TB and ART medications, MDR-TB/HIV co-infected patients can achieve culture conversion rates and times similar to those reported from HIV-negative patients worldwide. Future studies are needed to examine whether similar cure rates are achieved at the end of MDR-TB treatment and to determine the optimal use and timing of ART in the setting of MDR-TB treatment.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Anti-Retroviral Agents / therapeutic use
  • Antitubercular Agents / therapeutic use
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • Humans
  • Male
  • Remission Induction
  • Retrospective Studies
  • South Africa
  • Sputum / microbiology
  • Sputum / virology
  • Time Factors
  • Tuberculosis, Multidrug-Resistant / complications*
  • Tuberculosis, Multidrug-Resistant / drug therapy
  • Young Adult


  • Anti-Retroviral Agents
  • Antitubercular Agents