Declining prevalence of drug-resistant tuberculosis among HIV/tuberculosis co-infected patients receiving antiretroviral therapy.
BACKGROUND
Drug-resistant tuberculosis (DR-TB) is a serious threat in developing countries where the prevalence of both HIV and TB are high. Antiretroviral therapy (ART) has been more accessible in these countries. The present study aimed to determine the impact of ART on the prevalence of DR-TB among HIV/TB co-infected patients.


METHODS
A retrospective cohort study was conducted among HIV-infected patients with culture-proved TB from 1999 to 2004. Susceptibilities of Mycobacterium tuberculosis to antituberculous drugs and rate ofART use were studied.


RESULTS
There were 225 patients, mean age 35.8 years, 72.4% male and median CD, 44 cells/mm(3). Patients who had received ART increased from 18.5% in 1999 to 92.1% in 2004 (p<O. 001). The prevalence of DR-TB in the years 1999 and 2004 were 48% and 7.9%, respectively (p<O.001). The prevalence of isoniazid- and rifampicin-resistance significantly declined in 2004 when compared with those in 1999 (p<O. 05).


CONCLUSIONS
The declines in the prevalence of DR-TB, INH- and RFP-resistance in HIV/TB co-infected patients are possibly attributable to the use of ART In addition to the survival benefit from ART in HIV-infected patients, increasing use of ART among HIV-infected patients may eliminate DR-TB in this population.
Sungkanuparph
Somnuek
S
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama 6 Rd, Bangkok 10400, Thailand. rasuy@mahidol.ac.th
Eampokalap
Boonchuay
B
Chottanapund
Suthat
S
Bed
Supeda Thongyen
ST
Manosuthi
Weerawat
W
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015897:Comorbidity; D004977:Ethambutol / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D015995:Prevalence; D012189:Retrospective Studies; D012293:Rifampin / Q000494:pharmacology / Q000627:therapeutic use; D013307:Streptomycin / Q000627:therapeutic use; D013785:Thailand / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology
D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin