Survival odds are stacked against people co-infected with multidrug-resistant tuberculosis (MDR-TB) and HIV. HIV weakens the immune system, and co-infected patients have high mortality.

Several clinical trials have found that initiating antiretroviral therapy (ART) improves survival of patients co-infected with HIV and drug-susceptible TB. But it wasn’t known whether ART is similarly helpful for treating people co-infected with HIV and MDR-TB. Furthermore, treating both infections together could overburden patients with medication and cause harmful side effects. To help guide clinical practice, James Brust, M.D., with colleagues from Emory, the Centers for Disease Control and Prevention, and the University of KwaZulu-Natal, prospectively measured survival and treatment outcomes in MDR-TB/HIV co-infected patients on ART compared to outcomes in patients with MDR-TB alone.

The research was carried out at three drug-resistant TB referral hospitals in South Africa’s KwaZulu-Natal province. KwaZulu-Natal has nearly one-third of the country’s drug-resistant TB cases, of whom more than 70 percent are co-infected with HIV. Between 2011 and 2015 the researchers followed 206 patients, 150 of whom were HIV-infected.

Final MDR-TB outcomes were obtained for 191 of the participants—and were quite favorable. One hundred thirty (73 percent) were cured or successfully completed treatment. Although there was no significant survival difference between patients with and without HIV overall, those with a CD4 count persistently ≤100 cells/mm3 did have significantly higher mortality.

“Our data now provide compelling evidence that successful outcomes are possible in patients with MDR-TB and HIV co-infection and that ART should be initiated promptly,” the researchers concluded.

The study was published online on December 26 in Clinical Infectious Diseases. Dr. Brust is an associate professor of medicine at Einstein and Montefiore.