Multidrug-resistant TB and HIV in Thailand: overlapping, but not independently associated, risk factors.
The HIV and multi-drug resistant tuberculosis (MDR-TB) epidemics are closely linked. In Thailand as part of a sentinel surveillance system, we collected data prospectively about pulmonary TB cases treated in public clinics. A subset of HIV-infected TB patients identified through this system had additional data collected for a research study. We conducted multivariate analysis to identify factors associated with MDR-TB. Of 10,428 TB patients, 2,376 (23%) were HIV-infected; 145 (1%) had MDR-TB. Of the MDR-TB cases, 52 (37%) were HIV-infected. Independent risk factors for MDR-TB included age 18-29 years old, male sex, and previous TB treatment, but not HIV infection. Among new patients, having an injection drug use history was a risk factor for MDR-TB. Of 539 HIV-infected TB patients in the research study, MDR-TB was diagnosed in 19 (4%); the only significant risk factors were previous TB treatment and previous hepatitis. In Thailand, HIV is common among MDR-TB patients, but is not an independent risk factor for MDR-TB. Populations at high risk for HIV-young adults, men, injection drug users - should be prioritized for drug susceptibility testing.
Office of Disease Prevention and Control 7, Ubon Ratchathani, Thailand.
Somsak
S
Akksilp
Wanpen
W
Wattanaamornkiat
Wanitchaya
W
Kittikraisak
Sriprapa
S
Nateniyom
Somsak
S
Rienthong
Chawin
C
Sirinak
Keerataya
K
Ngamlert
Wiroj
W
Mankatittham
Wanchai
W
Sattayawuthipong
Surin
S
Sumnapun
Norio
N
Yamada
Patama
P
Monkongdee
Amornrat
A
Anuwatnonthakate
Channawong
C
Burapat
Charles D
CD
Wells
Jordan W
JW
Tappero
Jay K
JK
Varma
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012307:Risk Factors; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000150:complications; D013785:Thailand / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000453:epidemiology*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000453:epidemiology; D055815:Young Adult