Alarming levels of drug-resistant tuberculosis in HIV-infected patients in metropolitan Mumbai, India.

Abstract

BACKGROUND:

Drug-resistant tuberculosis (DR-TB) is a looming threat to tuberculosis control in India. However, no countrywide prevalence data are available. The burden of DR-TB in HIV-co-infected patients is likewise unknown. Undiagnosed and untreated DR-TB among HIV-infected patients is a major cause of mortality and morbidity. We aimed to assess the prevalence of DR-TB (defined as resistance to any anti-TB drug) in patients attending public antiretroviral treatment (ART) centers in greater metropolitan Mumbai, India.

METHODS:

A cross-sectional survey was conducted among adults and children ART-center attendees. Smear microscopy, culture and drug-susceptibility-testing (DST) against all first and second-line TB-drugs using phenotypic liquid culture (MGIT) were conducted on all presumptive tuberculosis patients. Analyses were performed to determine DR-TB prevalence and resistance patterns separately for new and previously treated, culture-positive TB-cases.

RESULTS:

Between March 2013 and January 2014, ART-center attendees were screened during 14135 visits, of whom 1724 had presumptive TB. Of 1724 attendees, 72 (4%) were smear-positive and 202 (12%) had a positive culture for Mycobacterium tuberculosis. Overall DR-TB was diagnosed in 68 (34%, 95% CI: 27%-40%) TB-patients. The proportions of DR-TB were 25% (29/114) and 44% (39/88) among new and previously treated cases respectively. The patterns of DR-TB were: 21% mono-resistant, 12% poly-resistant, 38% multidrug-resistant (MDR-TB), 21% pre-extensively-drug-resistant (MDR-TB plus resistance to either a fluoroquinolone or second-line injectable), 6% extensively drug-resistant (XDR-TB) and 2% extremely drug-resistant TB (XDR-TB plus resistance to any group-IV/V drug). Only previous history of TB was significantly associated with the diagnosis of DR-TB in multivariate models.

CONCLUSION:

The burden of DR-TB among HIV-infected patients attending public ART-centers in Mumbai was alarmingly high, likely representing ongoing transmission in the community and health facilities. These data highlight the need to promptly diagnose drug-resistance among all HIV-infected patients by systematically offering access to first and second-line DST to all patients with 'presumptive TB' rather than 'presumptive DR-TB' and tailor the treatment regimen based on the resistance patterns.

• Authors: Petros Isaakidis, Mrinalini Das, Ajay M V Kumar, Christopher Peskett, Minni Khetarpal, Arun Bamne, Balkrishna Adsul, Mamta Manglani, Kuldeep Singh Sachdeva, Malik Parmar, Avinash Kanchar, B B Rewari, Alaka Deshpande, Camilla Rodrigues, Anjali Shetty, Lorraine Rebello, Peter Saranchuk
• Journal: PloS one (PLoS One) Vol. 9 Issue 10 Pg. e110461 ( 2014) ISSN: 1932-6203 [Electronic] United States
• PMID: 25333696 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antitubercular Agents

Topics

• Adolescent
• Adult
• Antitubercular Agents (therapeutic use)
• Asian People
• Child
• Cross-Sectional Studies
• Demography
• Drug Therapy, Combination
• Female
• HIV Infections (complications, diagnosis)
• Humans
• India
• Male
• Mycobacterium tuberculosis (isolation & purification)
• Prevalence
• Tuberculosis (complications, drug therapy, epidemiology)
• Tuberculosis, Multidrug-Resistant (complications, drug therapy, epidemiology)
• Tuberculosis, Pulmonary (complications, drug therapy, epidemiology)