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TUBERCULOSIS MORTALITY, DRUG RESISTANCE, AND INFECTIOUSNESS IN PATIENTS WITH AND WITHOUT HIV INFECTION IN PERU

VIVIAN KAWAIAsociacion Benefica Prisma, Lima, Peru; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, Faculty of Sciences, Universidad Cayetano Heredia, Lima, Peru; U.S. Military HIV Research Program and the Henry M. Jackson Foundation, Inc., Rockville, Maryland; Department of Infectious Diseases & Immunity and Wellcome Centre for Clinical Tropical Medicine, Imperial College London, U.K.; Hospital Dos de Mayo, Lima, Perú; Hospital Maria Auxiliadora, Lima, Peru

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GISELLE SOTOAsociacion Benefica Prisma, Lima, Peru; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, Faculty of Sciences, Universidad Cayetano Heredia, Lima, Peru; U.S. Military HIV Research Program and the Henry M. Jackson Foundation, Inc., Rockville, Maryland; Department of Infectious Diseases & Immunity and Wellcome Centre for Clinical Tropical Medicine, Imperial College London, U.K.; Hospital Dos de Mayo, Lima, Perú; Hospital Maria Auxiliadora, Lima, Peru

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ROBERT H. GILMANAsociacion Benefica Prisma, Lima, Peru; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, Faculty of Sciences, Universidad Cayetano Heredia, Lima, Peru; U.S. Military HIV Research Program and the Henry M. Jackson Foundation, Inc., Rockville, Maryland; Department of Infectious Diseases & Immunity and Wellcome Centre for Clinical Tropical Medicine, Imperial College London, U.K.; Hospital Dos de Mayo, Lima, Perú; Hospital Maria Auxiliadora, Lima, Peru

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CHRISTIAN T. BAUTISTAAsociacion Benefica Prisma, Lima, Peru; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, Faculty of Sciences, Universidad Cayetano Heredia, Lima, Peru; U.S. Military HIV Research Program and the Henry M. Jackson Foundation, Inc., Rockville, Maryland; Department of Infectious Diseases & Immunity and Wellcome Centre for Clinical Tropical Medicine, Imperial College London, U.K.; Hospital Dos de Mayo, Lima, Perú; Hospital Maria Auxiliadora, Lima, Peru

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LUZ CAVIEDESAsociacion Benefica Prisma, Lima, Peru; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, Faculty of Sciences, Universidad Cayetano Heredia, Lima, Peru; U.S. Military HIV Research Program and the Henry M. Jackson Foundation, Inc., Rockville, Maryland; Department of Infectious Diseases & Immunity and Wellcome Centre for Clinical Tropical Medicine, Imperial College London, U.K.; Hospital Dos de Mayo, Lima, Perú; Hospital Maria Auxiliadora, Lima, Peru

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LUZ HUAROTOAsociacion Benefica Prisma, Lima, Peru; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, Faculty of Sciences, Universidad Cayetano Heredia, Lima, Peru; U.S. Military HIV Research Program and the Henry M. Jackson Foundation, Inc., Rockville, Maryland; Department of Infectious Diseases & Immunity and Wellcome Centre for Clinical Tropical Medicine, Imperial College London, U.K.; Hospital Dos de Mayo, Lima, Perú; Hospital Maria Auxiliadora, Lima, Peru

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EDUARDO TICONAAsociacion Benefica Prisma, Lima, Peru; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, Faculty of Sciences, Universidad Cayetano Heredia, Lima, Peru; U.S. Military HIV Research Program and the Henry M. Jackson Foundation, Inc., Rockville, Maryland; Department of Infectious Diseases & Immunity and Wellcome Centre for Clinical Tropical Medicine, Imperial College London, U.K.; Hospital Dos de Mayo, Lima, Perú; Hospital Maria Auxiliadora, Lima, Peru

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JAIME ORTIZAsociacion Benefica Prisma, Lima, Peru; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, Faculty of Sciences, Universidad Cayetano Heredia, Lima, Peru; U.S. Military HIV Research Program and the Henry M. Jackson Foundation, Inc., Rockville, Maryland; Department of Infectious Diseases & Immunity and Wellcome Centre for Clinical Tropical Medicine, Imperial College London, U.K.; Hospital Dos de Mayo, Lima, Perú; Hospital Maria Auxiliadora, Lima, Peru

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MARCO TOVARAsociacion Benefica Prisma, Lima, Peru; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, Faculty of Sciences, Universidad Cayetano Heredia, Lima, Peru; U.S. Military HIV Research Program and the Henry M. Jackson Foundation, Inc., Rockville, Maryland; Department of Infectious Diseases & Immunity and Wellcome Centre for Clinical Tropical Medicine, Imperial College London, U.K.; Hospital Dos de Mayo, Lima, Perú; Hospital Maria Auxiliadora, Lima, Peru

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VICTOR CHAVEZAsociacion Benefica Prisma, Lima, Peru; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, Faculty of Sciences, Universidad Cayetano Heredia, Lima, Peru; U.S. Military HIV Research Program and the Henry M. Jackson Foundation, Inc., Rockville, Maryland; Department of Infectious Diseases & Immunity and Wellcome Centre for Clinical Tropical Medicine, Imperial College London, U.K.; Hospital Dos de Mayo, Lima, Perú; Hospital Maria Auxiliadora, Lima, Peru

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RICHARD RODRIGUEZAsociacion Benefica Prisma, Lima, Peru; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, Faculty of Sciences, Universidad Cayetano Heredia, Lima, Peru; U.S. Military HIV Research Program and the Henry M. Jackson Foundation, Inc., Rockville, Maryland; Department of Infectious Diseases & Immunity and Wellcome Centre for Clinical Tropical Medicine, Imperial College London, U.K.; Hospital Dos de Mayo, Lima, Perú; Hospital Maria Auxiliadora, Lima, Peru

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A. RODERICK ESCOMBEAsociacion Benefica Prisma, Lima, Peru; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, Faculty of Sciences, Universidad Cayetano Heredia, Lima, Peru; U.S. Military HIV Research Program and the Henry M. Jackson Foundation, Inc., Rockville, Maryland; Department of Infectious Diseases & Immunity and Wellcome Centre for Clinical Tropical Medicine, Imperial College London, U.K.; Hospital Dos de Mayo, Lima, Perú; Hospital Maria Auxiliadora, Lima, Peru

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CARLTON A. EVANSAsociacion Benefica Prisma, Lima, Peru; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, Faculty of Sciences, Universidad Cayetano Heredia, Lima, Peru; U.S. Military HIV Research Program and the Henry M. Jackson Foundation, Inc., Rockville, Maryland; Department of Infectious Diseases & Immunity and Wellcome Centre for Clinical Tropical Medicine, Imperial College London, U.K.; Hospital Dos de Mayo, Lima, Perú; Hospital Maria Auxiliadora, Lima, Peru

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The effects of HIV co-infection and multi-drug resistant tuberculosis (MDRTB) on tuberculosis prognosis are poorly defined. Therefore, we studied infectiousness and mortality of 287 tuberculosis patients treated with standard, directly observed, short-course therapy in the Peruvian community. During 6–17 months of treatment, 49 (18%) of patients died, of whom 48 (98%) had AIDS and 28 (57%) had MDRTB; 17/31 (55%) of MDRTB-patients with AIDS died within 2 months of diagnosis, before traditional susceptibility testing would have identified their MDRTB. Most non-MDRTB became smear- and culture-negative within 6 weeks of therapy, whereas most MDRTB remained sputum-culture-positive until death or treatment completion. HIV-negative patients with non-MDRTB had good outcomes. However, MDRTB was associated with prolonged infectiousness and HIV co-infection with early mortality, indicating a need for greater access to anti-retroviral therapy. Furthermore, early and rapid tuberculosis drug-susceptibility testing and infection control are required so that MDRTB can be appropriately treated early enough to reduce mortality and transmission.

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