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PLoS One. 2014 Oct 21;9(10):e110461. doi: 10.1371/journal.pone.0110461. eCollection 2014.

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

Author information

1
Médecins Sans Frontières, Mumbai, India.
2
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
3
City TB Office, Bawala Wadi, Chinckpokli, Mumbai, India.
4
Brihanmumbai Municipal Corporation, Mumbai, India.
5
Mumbai District AIDS Control Society (MDACS), Mumbai, India.
6
Pediatric Centre of Excellence for HIV Care, L.T.M. Medical College & General Hospital, Sion, Mumbai, India.
7
Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, India.
8
World Health Organisation - Country Office for India, New Delhi, India.
9
Department of AIDS Control, National AIDS Control Organisation, New Delhi, India.
10
MGM Institute of Health Sciences, Navi Mumbai, India.
11
P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India.
12
Southern Africa Medical Unit (SAMU), Médecins Sans Frontières, Cape Town, South Africa.

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.

PMID:
25333696
PMCID:
PMC4204864
DOI:
10.1371/journal.pone.0110461
[Indexed for MEDLINE]
Free PMC Article

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