Characteristics of drug resistance and HIV among tuberculosis patients in Mozambique.
METHODS
The rate of human immunodeficiency virus (HIV) seroprevalence among tuberculosis patients varies between 2% and 53% in Mozambique, depending on the region. Drug resistance surveillance has been performed in only a few cities in Mozambique.


OBJECTIVE
To establish the extent of drug resistance in areas of Mozambique with different levels of HIV prevalence, to estimate the prevalence of HIV among tuberculosis (TB) patients, and to examine the association between drug resistance and HIV infection.


METHODS
All tuberculosis patients diagnosed at randomly selected health facilities over 9 months (September 1998 to June 1999) were enrolled in the study. Sputum was collected, smeared and cultured, and drug susceptibility tests were performed. Blood was tested for HIV in the respective provinces, and patients received pre-test and post-test counselling.


RESULTS
Of 709 culture-positive cases, 25.5% were HIV-positive. HIV-positive patients were significantly more likely to have a prior history of treatment (OR 2.2; 95% CI 1.9-3.6) and resistance to both isoniazid and streptomycin (OR 2.3; 95% CI 1.3, 4.5). In patients with no history of prior tuberculosis treatment, the multidrug resistance rate was 3.4% and resistance to isoniazid and streptomycin (HS) was 5.2%. Any drug resistance was significantly more common among those with a history of prior treatment (OR 3.1; 95% CI 2.1-4.7), particularly resistance to HS (OR 4.5; 95% CI 2.6-7.9).


CONCLUSIONS
This study demonstrates substantial levels of drug resistance in Mozambique. Differences in drug resistance between high and low HIV prevalence areas may be related to prior treatment.
Mac-Arthur
A
A
National Tuberculosis and Leprosy Control Programme, Ministry of Health of Mozambique, Maputo. TBLEPRA@dnsdee.imoz.com
Gloyd
S
S
Perdigão
P
P
Noya
A
A
Sacarlal
J
J
Kreiss
J
J
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018432:Drug Resistance, Multiple; D005260:Female; D006678:HIV / Q000187:drug effects*; D015528:HIV Seroprevalence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009073:Mozambique / Q000453:epidemiology; D011897:Random Allocation; D012680:Sensitivity and Specificity; D013307:Streptomycin / Q000627:therapeutic use; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality
D000904:Antibiotics, Antitubercular; D007538:Isoniazid; D013307:Streptomycin