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Conradie F, Bagdasaryan TR, Borisov S, Howell P, Mikiashvili L, Ngubane N, Samoilova A, Skornykova S, Tudor E, Variava E, Yablonskiy P, Everitt D, Wills GH, Sun E, Olugbosi M, Egizi E, Li M, Holsta A, Timm J, Bateson A, Crook AM, Fabiane SM, Hunt R, McHugh TD, Tweed CD, Foraida S, Mendel CM, Spigelman M. Bedaquiline-Pretomanid-Linezolid Regimens for Drug-Resistant Tuberculosis. N Engl J Med 2022; 387:810-823. [PMID: 36053506 PMCID: PMC9490302 DOI: 10.1056/nejmoa2119430] [Citation(s) in RCA: 184] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The bedaquiline-pretomanid-linezolid regimen has been reported to have 90% efficacy against highly drug-resistant tuberculosis, but the incidence of adverse events with 1200 mg of linezolid daily has been high. The appropriate dose of linezolid and duration of treatment with this agent to minimize toxic effects while maintaining efficacy against highly drug-resistant tuberculosis are unclear. METHODS We enrolled participants with extensively drug-resistant (XDR) tuberculosis (i.e., resistant to rifampin, a fluoroquinolone, and an aminoglycoside), pre-XDR tuberculosis (i.e., resistant to rifampin and to either a fluoroquinolone or an aminoglycoside), or rifampin-resistant tuberculosis that was not responsive to treatment or for which a second-line regimen had been discontinued because of side effects. We randomly assigned the participants to receive bedaquiline for 26 weeks (200 mg daily for 8 weeks, then 100 mg daily for 18 weeks), pretomanid (200 mg daily for 26 weeks), and daily linezolid at a dose of 1200 mg for 26 weeks or 9 weeks or 600 mg for 26 weeks or 9 weeks. The primary end point in the modified intention-to-treat population was the incidence of an unfavorable outcome, defined as treatment failure or disease relapse (clinical or bacteriologic) at 26 weeks after completion of treatment. Safety was also evaluated. RESULTS A total of 181 participants were enrolled, 88% of whom had XDR or pre-XDR tuberculosis. Among participants who received bedaquiline-pretomanid-linezolid with linezolid at a dose of 1200 mg for 26 weeks or 9 weeks or 600 mg for 26 weeks or 9 weeks, 93%, 89%, 91%, and 84%, respectively, had a favorable outcome; peripheral neuropathy occurred in 38%, 24%, 24%, and 13%, respectively; myelosuppression occurred in 22%, 15%, 2%, and 7%, respectively; and the linezolid dose was modified (i.e., interrupted, reduced, or discontinued) in 51%, 30%, 13%, and 13%, respectively. Optic neuropathy developed in 4 participants (9%) who had received linezolid at a dose of 1200 mg for 26 weeks; all the cases resolved. Six of the seven unfavorable microbiologic outcomes through 78 weeks of follow-up occurred in participants assigned to the 9-week linezolid groups. CONCLUSIONS A total of 84 to 93% of the participants across all four bedaquiline-pretomanid-linezolid treatment groups had a favorable outcome. The overall risk-benefit ratio favored the group that received the three-drug regimen with linezolid at a dose of 600 mg for 26 weeks, with a lower incidence of adverse events reported and fewer linezolid dose modifications. (Funded by the TB Alliance and others; ZeNix ClinicalTrials.gov number, NCT03086486.).
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Affiliation(s)
- Francesca Conradie
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Tatevik R Bagdasaryan
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Sergey Borisov
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Pauline Howell
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Lali Mikiashvili
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Nosipho Ngubane
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Anastasia Samoilova
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Sergey Skornykova
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Elena Tudor
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Ebrahim Variava
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Petr Yablonskiy
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Daniel Everitt
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Genevieve H Wills
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Eugene Sun
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Morounfolu Olugbosi
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Erica Egizi
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Mengchun Li
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Alda Holsta
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Juliano Timm
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Anna Bateson
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Angela M Crook
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Stella M Fabiane
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Robert Hunt
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Timothy D McHugh
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Conor D Tweed
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Salah Foraida
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Carl M Mendel
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
| | - Melvin Spigelman
- From the Clinical HIV Research Unit (F.C., P.H.) and Klerksdorp-Tshepong Hospital Complex, Department of Internal Medicine (E.V.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, the Clinical HIV Research Unit, King DinuZulu Hospital, Durban (N.N.), and the TB Alliance, Pretoria (M.O.) - all in South Africa; the Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow (T.R.B.), Moscow City Research and Practice Tuberculosis Treatment Center (S.B.), and National Medical Research Center of Phthisiopulmonology and Infectious Diseases (A.S.), Moscow, Ural Research Institute of Phthisiopulmonology, Yekaterinburg (S.S.), and St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg (P.Y.) - all in Russia; the National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia (L.M.); the Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Moldova (E.T.); the TB Alliance, New York (D.E., E.S., E.E., M.L., A.H., J.T., S.F., C.M.M., M.S.); and the Medical Research Council Clinical Trials Unit at University College London (G.H.W., A.M.C., S.M.F., C.D.T.) and the University College London Centre for Clinical Microbiology (A.B., R.H., T.D.M.), University College London, London
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