title: High prevalence of drug resistance amongst HIV-exposed and -infected children in a tuberculosis prevention trial.
abstract: An emergence of drug-resistant tuberculosis (DR-TB) in settings affected by human immunodeficiency virus (HIV) and tuberculosis (TB) has been observed. We investigated the prevalence of DR-TB in P1041, a multicentered, randomised, double-blind trial which compared the administration of isoniazid (INH) to placebo, in HIV-exposed, non-infected and -infected African infants in the absence of any documented TB exposure. The prevalence of multidrug-resistant TB (MDR-TB) was 22.2% (95%CI 8.5-45.8) and INH monoresistance 5.6% (95%CI 0.1-27.6) among culture-confirmed cases, with all MDR-TB occurring in a single site. There was no association between INH treatment or placebo group, or between HIV infection status, and DR-TB prevalence. There was a high prevalence of DR-TB among HIV-exposed and -infected children. Surveillance of DR-TB among children in high-burden TB-HIV settings should be routine.
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa. annekeh@sun.ac.za
authors.forename: A C
authors.initials: AC
authors.lastname: Hesseling
authors.forename: S
authors.initials: S
authors.lastname: Kim
authors.forename: S
authors.initials: S
authors.lastname: Madhi
authors.forename: S
authors.initials: S
authors.lastname: Nachman
authors.forename: H S
authors.initials: HS
authors.lastname: Schaaf
authors.forename: A
authors.initials: A
authors.lastname: Violari
authors.forename: T C
authors.initials: TC
authors.lastname: Victor
authors.forename: G
authors.initials: G
authors.lastname: McSherry
authors.forename: C
authors.initials: C
authors.lastname: Mitchell
authors.forename: M F
authors.initials: MF
authors.lastname: Cotton
mesh_terms: D000293:Adolescent; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007538:Isoniazid / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid