Linezolid for multidrug-resistant tuberculosis in HIV-infected and -uninfected patients

Two recent systematic reviews found that treatment outcomes with regimens containing linezolid for complicated cases of multidrug-resistant (MDR) tuberculosis (TB) are equal to or better than those reported for uncomplicated MDR-TB [1, 2] and better than those reported among patients treated for extensively drug-resistant (XDR)-TB [3–6]. Existing data on treatment outcomes with linezolid for MDR-TB are predominantly among HIV-uninfected patients; <10% of patients were HIV co-infected in the reviews [1, 2]. There is concern over the safety of using linezolid within MDR-TB regimens for HIV-infected patients due to underlying HIV-related neuropathy and bone marrow dysfunction as well as a potentially higher incidence of adverse events in patients on antiretroviral therapy (ART), notably anaemia with zidovudine and peripheral neuropathy with stavudine [7]. Given the high rate of HIV/TB co-infection in many settings, we report here our clinical experience with the use of linezolid for treatment of XDR-TB and complicated MDR-TB among HIV-infected and -uninfected patients in community-based programmes supported by Médecins Sans Frontières (MSF) in two high-burden settings in Khayelitsha, South Africa [8], and Mumbai, India [7]. We carried out a retrospective analysis of routinely collected data. Programmes at both sites were approved by either MSF or local university ethics review boards. Due to restricted access to linezolid in South Africa as well as limited capacity for operational research in both programmes, the numbers are small, and data were collected and analysed over a limited time period only. Linezolid is an effective treatment option for MDR/XDR-TB, including among HIV-co-infected patients on ART