Anti-tuberculosis drug resistance in patients with HIV and tuberculosis in South India.

Swaminathan, S.; Paramasivan, C.N.; Ponnuraja, C.; Iliayas, S; Rajasekaran, S.; Narayanan, P. R.

International Journal of Tuberculosis and Lung Disease; 2005; 9; 896-900.

Summary: Setting: Tuberculosis Research Centre clinics at Chennai and Madurai, Tamil Nadu, South India.

Objectives: To investigate the prevalence and pattern of drug resistance among patients with HIV and pulmonary tuberculosis (PTB).

Design: Prospective cohort study of HIV-positive patients with PTB between January 2001 and May 2003. Sputum mycobacterial culture and drug susceptibility testing were performed.

Results : A total of 204 patients with positive sputum cultures for Mycobacterium tuberculosis were included; 167 of them were new cases, and 37 had a history of previous anti-tuberculosis treatment for > 1 month. Among the former, resistance to isoniazid (INH) was observed in 22 (13%) and MDR-TB in 7 (4.2%). Reported resistance rates in this geographic area among new cases ranged from 15% to 28% for INH and 2.8% to 3.4% for MDR (INH + rifampicin [RMP]). In contrast, among HIV-positive patients with a history of previous treatment, resistance was found to INH in 10 (27%) and to RMP in 7 (18.9%), while MDR-TB was seen in 5 (13.5%) patients.

Conclusion : Among new TB patients, MDR-TB is marginally higher in HIV-positive patients than in the non-HIV-infected population in this region. Standard treatment guidelines should be followed. Higher rates of drug resistance are observed among previously treated patients.

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