Kylie Pack

Evelyn Galvez
BIO 1615
April 5, 2016
Tuberculosis Mortality, Drug Resistance, and Infectiousness in Patients with and Without HIV
Infection in Peru
(Article Summary)
Introduction
Tuberculosis (TB) is an infection resulting from bacterium, specifically Mycobacterium
tuberculosis. This infection normally affects the lungs but can affect other areas of the body as
well, including the kidneys, the spine, and the brain (Basic TB Facts, 2012). In many cases, TB
has undergone natural selection and become resistant to antibiotics; this type of TB is called
multidrug resistant tuberculosis (MDRTB). While there are treatments for TB, its combination
with human immunodeficiency virus (HIV) and/or MDRTB in some people leads to unknown
prognoses. The seriousness of TB can be seen when one looks at the statistics of the problem: TB
kills 1.7 million people a year. Medicine leads to favorable prognosis, but when combined with
HIV and/or (MDRTB), not much is known about the effects of treatment (Kawai et al., 2006, p.
1027).
With Peru being one of the eight most affected places by MDRTB, a group of scientists
there set out to learn more about the prognosis of those with HIV and TB, or MDRTB, which
previously has been largely undefined. Doing such research was meant to increase the
understanding of professionals in order to provide better patient care. The goal was to study the
consequences of HIV and MDRTB on TB infectiousness and mortality during TB therapy. With a
better understanding of the topic, more people can be helped effectively (Kawai et al., 2006, p.
1027).

Materials and Methods

Over the course of 17 months, 287 people with TB from two different hospitals in Peru,
64 (22%) of whom were also diagnosed with HIV at Dos de Mayo Hospital, were selected and
examined throughout their treatment. For up to 17 months, each patient was given the standard
Peruvian first-line TB treatment. The majority of the patients were treated with isoniazid (H),
rifampicin (R), pyrazinamide (Z), and ethambutol (E) for 2 months, 6 days a week. Following
this treatment, patients were treated for another 4 months with H and R 2 days a week. Those
known to have HIV as well were treated similarly but for 7 months instead of 4. In addition,
those who had been previously treated for TB also received streptomycin (S). Only 12 of the
patients underwent second-line drugs for a short time because of cost and availability. To follow
up, samples were collected from each patient (Kawai et al., 2006, p. 1027-28).
Results
Unfortunately, 49 (17%) patients whom researchers followed up on did not live. 48 (67%) out of
72 HIV infected individuals did not survive, in comparison to 1 (0.5%) of 215 patients without
HIV, who died of hepatitis. Another 18% of all of the patients were diagnosed with MDRTB and
71% of all patients who died had MDRTB. The main forecaster for mortality was HIV infection,
with MDRTB also playing a significant part in association with death. Two months after
diagnosis, 55% of deaths were caused by a co-infection of HIV and MDRTB. Only 16% of those
lived long enough to complete 9 months of treatment (Kawai et al., 2006, p. 1028-29).
Prior to this experiment, the prognosis of those having a co-infection of TB or MDRTB and
HIV was largely unknown. However, through this experiment, it became very apparent that HIV

and multi-drug resistance actually have a substantial influence on survival rates among those
with TB (Kawai et al., 2006, p. 1027-29).
Discussion
A bigger population as well as more variety in the locations with more diversity may be
helpful and provide more accurate results, but even this small sample from two locations within
Peru yielded noteworthy and reliable results. All 287 patients were located in Peru, which created
a somewhat less diverse testing sample (Kawai et al., 2006, p. 1027).
Though the researchers did not necessarily have a hypothesis, they did achieve the goal
of their experiment by reaching conclusions about the effects that co-infections of TB or
MDRTB and HIV have on mortality and infectiousness. With better clarity now found on this
topic, the researchers were able to conclude that non-MDRTB patients experienced relatively
rapid recoveries, while those with MDRTB and/or HIV had a much lower chance of survival.
Likewise, they were much more infectious and for longer periods of times. This suggests the
value and importance behind early and testing, better infection control, and early intervention
with treatments in order to increase survival rates and decrease the infection of others. The
authors have noted, Greater use of drug-susceptibility testing would allow appropriate therapy,
when available, to improve prognosis and potentially reduce MDRTB transmission (Kawai et
al., 2006, p. 1031).

References
Basic TB Facts. (2012, March 13). Retrieved April 04, 2016, from
http://www.cdc.gov/tb/topic/basics/default.htm
Kawai, V., Soto, G., Gilman, R. H., Bautista, C. T., L. C., Hauroto, L., . . . Evans, C. A. (2006).
Tuberculosis Mortality, Drug Resistance, and Infectiousness in Patients with and Without
HIV Infection in Peru (Rep.). The American Society of Tropical Medicine and Hygiene.