title: Multi-drug resistant TB and HIV in Thailand: overlapping, but not independently associated risk factors.
abstract: 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.
authors.affiliation: Office of Disease Prevention and Control 7, Ubon Ratchathani, US Centers for Disease Control and Prevention Collaboration, Nonthaburi.
authors.forename: Somsak
authors.initials: S
authors.lastname: Akksilp
authors.forename: Wanpen
authors.initials: W
authors.lastname: Wattanaamornkiat
authors.forename: Wanitchaya
authors.initials: W
authors.lastname: Kittikraisak
authors.forename: Sriprapa
authors.initials: S
authors.lastname: Nateniyom
authors.forename: Somsak
authors.initials: S
authors.lastname: Rienthong
authors.forename: Chawin
authors.initials: C
authors.lastname: Sirinak
authors.forename: Keerataya
authors.initials: K
authors.lastname: Ngamlert
authors.forename: Wiroj
authors.initials: W
authors.lastname: Mankatittham
authors.forename: Wanchai
authors.initials: W
authors.lastname: Sattayawuthipong
authors.forename: Surin
authors.initials: S
authors.lastname: Sumnapun
authors.forename: Norio
authors.initials: N
authors.lastname: Yamada
authors.forename: Patama
authors.initials: P
authors.lastname: Monkongdee
authors.forename: Amornrat
authors.initials: A
authors.lastname: Anuwatnonthakate
authors.forename: Channawong
authors.initials: C
authors.lastname: Burapat
authors.forename: Charles D
authors.initials: CD
authors.lastname: Wells
authors.forename: Jordan W
authors.initials: JW
authors.lastname: Tappero
authors.forename: Jay K
authors.initials: JK
authors.lastname: Varma
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D018571:Sentinel Surveillance; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology; D013785:Thailand / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000453:epidemiology*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000453:epidemiology