PLoS ONE (Jan 2008)

Management of extensively drug-resistant tuberculosis in Peru: cure is possible.

  • Cesar A Bonilla,
  • Aldo Crossa,
  • Hector O Jave,
  • Carole D Mitnick,
  • Ronal B Jamanca,
  • Cesar Herrera,
  • Luis Asencios,
  • Alberto Mendoza,
  • Jaime Bayona,
  • Matteo Zignol,
  • Ernesto Jaramillo

DOI
https://doi.org/10.1371/journal.pone.0002957
Journal volume & issue
Vol. 3, no. 8
p. e2957

Abstract

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AIM: To describe the incidence of extensive drug-resistant tuberculosis (XDR-TB) reported in the Peruvian National multidrug-resistant tuberculosis (MDR-TB) registry over a period of more than ten years and present the treatment outcomes for a cohort of these patients. METHODS: From the Peruvian MDR-TB registry we extracted all entries that were approved for second-line anti-TB treatment between January 1997 and June of 2007 and that had Drug Susceptibility Test (DST) results indicating resistance to both rifampicin and isoniazid (i.e. MDR-TB) in addition to results for at least one fluoroquinolone and one second-line injectable (amikacin, capreomycin and kanamycin). RESULTS: Of 1,989 confirmed MDR-TB cases with second-line DSTs, 119(6.0%) XDR-TB cases were detected between January 1997 and June of 2007. Lima and its metropolitan area account for 91% of cases, a distribution statistically similar to that of MDR-TB. A total of 43 XDR-TB cases were included in the cohort analysis, 37 of them received ITR. Of these, 17(46%) were cured, 8(22%) died and 11(30%) either failed or defaulted treatment. Of the 14 XDR-TB patients diagnosed as such before ITR treatment initiation, 10 (71%) were cured and the median conversion time was 2 months. CONCLUSION: In the Peruvian context, with long experience in treating MDR-TB and low HIV burden, although the overall cure rate was poor, a large proportion of XDR-TB patients can be cured if DST to second-line drugs is performed early and treatment is delivered according to the WHO Guidelines.