Background Given very limited data, we assessed the long-term outcomes among patients with extensively drug-resistant (XDR) tuberculosis (TB). Methods A retrospective population-based cohort study was performed in patients with XDR-TB diagnosed during 2011–2013 in the country of Georgia. Data were abstracted from the National TB Program, medical charts, interviews, and the national Georgian death registry. Results Among 111 patients starting treatment for XDR-TB, 59 (53.2%) had newly diagnosed tuberculosis, and 3 (2.9%) had human immunodeficiency virus (HIV) coinfection. The median length of follow-up from diagnosis of XDR-TB to death or the end of study was 53.9 months (interquartile range, 27.2–66.3 months). End-of-treatment outcomes were available for 106 patients; 35 (33.0%) had a favorable outcome, and 71 (67.0%) had an unfavorable outcome, including death in 16 (15.1%). An additional 20 patients died after cessation of initial treatment, increasing the overall mortality rate to 34.0%. In multivariable analysis, an unfavorable initial end-of-treatment outcome was associated with posttreatment death (adjusted odds ratio, 14.41; 95% confidence interval, 1.78–117.13). Conclusions The overall mortality rate and specifically the posttreatment mortality rate were high among patients with XDR-TB. Patients with an unfavorable end-of-treatment outcome had an increased risk of death during follow-up. Our findings highlight the need for improved adherence, better-tolerated and shorter therapies, and enhanced posttreatment surveillance among patients treated for XDR-TB.

The incidence of anal cancer is increased in HIV-infected patients compared with the general population. Risk factors associated with the anal cancer precursor, high-grade squamous intraepithelial lesion (HSIL), have not been extensively studied in an urban black population with late-stage HIV disease. We performed a retrospective chart review of HIV-infected men at the Grady Ponce de Leon Center HIV Clinic (Atlanta, GA) referred for high-resolution anoscopy (HRA), a procedure where anal tissue is examined under magnification and abnormal areas are biopsied. Between December 2013 and September 2015, 147 men underwent HRA: 72% were black, and 94% were men who have sex with men. CD4 count closest to time of HRA was a median 325 cells/mm (interquartile range 203-473), and 69% had an undetectable HIV viral load. Ninety-four percent had abnormal anal cytology [80% atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion (LSIL) and 20% atypical squamous cells, cannot exclude HSIL/HSIL], and 97% had abnormal histology (35% LSIL, 65% HSIL). Statistically significant variables associated with HSIL included number of biopsies [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.13-2.14] and having ≥1 high-grade anal cytology in the last 12 months (OR 3.76, 95% CI 1.38-10.23). No significant association was found between HSIL and CD4, HIV viral load, or recent sexually transmitted infection. In this population, the burden of anal HSIL was extremely high, regardless of most recent anal cytology result. In newly diagnosed HIV-infected men with no history of anal cancer screening, performing HRA as primary anal cancer screening instead of cytology appears to be a viable option.

10605 Background: Optimal chemotherapy (CT) for advanced breast cancer treatment should be effective, well tolerated and convenient. Although the optimum CT is not defined, oral chemotherapy is an attractive option for many patients. Methods: We report a phase II multicentric study, first and second line metastatic breast cancer (MBC) treatment, at least one measurable lesion, prospectively collected data between 2003 and 2005. Treatment schedule: vinorelbine 60 mg/m2 p.o. day 1 and 8, capecitabine 1000 mg/m2 twice daily, day 1–14 q 21 days. Patients: 84 patients with MBC have been registered. Mean age 58.1 years, ranges (39.7 years–71.9 years). All patients had received prior adjuvant anthracycline based chemotherapy (CT). No adjuvant or palliative CT within the last 12 months, no concomitant hormonal treatment. Results: The median number of oral chemotherapy cycles vinorelbine plus capecitabine was 6 cycles (ranges 1 cycle - 19 cycles), total number of cycles was 550. In 84 evaluable pts the objective tumor response was achieved in 46 pts 55%, (ORR = CR + PR), complete response CR was achieved in 11 (13%) pts, partial response in 35 pts (42%), stable disease in 26 pts (31%). Median follow up was 9.7 months. In the intent-to-treat analysis, median time to progression was 6.7 months, median survival not reached, 58 pts (69%) are still alive. Reported NCI grade 3 - 4 toxicities: neutropenia in 4 pts (5%), febrile neutropenia in 4 pts (5%), vomiting in 6 pts (7%) Conclusion: Oral vinorelbine-capecitabine combination shows very promising activity and low toxicity in the MBC treatment. No significant financial relationships to disclose.

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