Padayatchi, Nesri.Naidoo, Kogieleum.Grobler, Anna Christina.Abdool Karim, Salim Safurdeen.Friedland, Gerald H.2016-09-142016-09-1420142014Padayatchi, N.; Abdool Karim, S.S.; Naidoo, K.; Grobler, A.; Friedland, G. 2014. Improved survival in multidrug-resistant tuberculosis patients receiving integrated tuberculosis and antiretroviral treatment in the SAPiT trial. International Journal of Tuberculosis and Lung Disease 18(2), 147-154.http://dx.doi.org/10.5588/ijtld.13.0627http://hdl.handle.net/10413/13345Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa. Departments of Internal Medicine and Epidemiology, Yale University School of Medicine, New Haven, Connecticut, USA.BACKGROUND: The therapeutic effects of antiretroviral treatment (ART) in patients with multidrug-resistant tuberculosis (MDR-TB) and human immunodeficiency virus (HIV) infection have not been established. Objective : To assess therapeutic outcomes of integrating ART with treatment for MDR-TB. Design: A subgroup of MDR-TB patients from a randomised controlled trial, the SAPiT (Starting Antiretroviral Therapy at Three Points in Tuberculosis) study, conducted in an out-patient clinic in Durban, South Africa, from 2008 to 2012. Methods : Clinical outcomes at 18 months were compared in patients randomised to receive ART within 12 weeks of initiating standard first-line anti-tuberculosis treatment with those who commenced ART after completing anti-tuberculosis treatment. Results : Mycobacterium tuberculosis drug susceptibility results were available in 489 (76%) of 642 SAPiT patients: 23 had MDR-TB, 14 in the integrated treatment arm and 9 in the sequential treatment arm. At 18 months, the mortality rate was 11.9/100 person-years (py; 95%CI 1.4–42.8) in the combined integrated treatment arm and 56.0/100 py (95%CI 18.2–130.8) in the sequential treatment arm (hazard ratio adjusted for baseline CD4 count and whether MDR-TB treatment was initiated: 0.14; 95%CI 0.02–0.94, P " 0.04). Conclusion: Despite the small sample size, the 86% reduction in mortality due to early initiation of ART in MDR-TB patients was statistically significant.enHIV treatment.MDR-TB.MDR-TB.HIV treatment.Peer reviewed journal article