Drug-resistant tuberculosis among HIV-infected patients starting antiretroviral therapy in Durban, South Africa.
OBJECTIVE
To estimate the prevalence of drug-resistant tuberculosis (TB) and describe the resistance patterns in patients commencing antiretroviral therapy (ART) in an HIV clinic in Durban, South Africa.


METHODS
Cross-sectional cohort study.


METHODS
Consecutive HIV-infected adults (≥ 18y/o) initiating HIV care were enrolled from May 2007-May 2008, regardless of signs or symptoms of active TB. Prior TB history and current TB treatment status were self-reported. Subjects expectorated sputum for culture (MGIT liquid and 7H11 solid medium). Positive cultures were tested for susceptibility to first- and second-line anti-tuberculous drugs. The prevalence of drug-resistant TB, stratified by prior TB history and current TB treatment status, was assessed.


RESULTS
1,035 subjects had complete culture results. Median CD4 count was 92/µl (IQR 42-150/µl). 267 subjects (26%) reported a prior history of TB and 210 (20%) were receiving TB treatment at enrollment; 191 (18%) subjects had positive sputum cultures, among whom the estimated prevalence of resistance to any antituberculous drug was 7.4% (95% CI 4.0-12.4). Among those with prior TB, the prevalence of resistance was 15.4% (95% CI 5.9-30.5) compared to 5.2% (95% CI 2.1-8.9) among those with no prior TB. 5.1% (95% CI 2.4-9.5) had rifampin or rifampin plus INH resistance.


CONCLUSIONS
The prevalence of TB resistance to at least one drug was 7.4% among adults with positive TB cultures initiating ART in Durban, South Africa, with 5.1% having rifampin or rifampin plus INH resistance. Improved tools for diagnosing TB and drug resistance are urgently needed in areas of high HIV/TB prevalence.
Harvard Medical School, Boston, Massachusetts, United States of America.
Jeffrey K
JK
Hom
Bingxia
B
Wang
Senica
S
Chetty
Janet
J
Giddy
Matilda
M
Mazibuko
Jenny
J
Allen
Rochelle P
RP
Walensky
Elena
E
Losina
Kenneth A
KA
Freedberg
Ingrid V
IV
Bassett
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial / Q000502:physiology; D004977:Ethambutol; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D007538:Isoniazid; D007612:Kanamycin; D008297:Male; D015995:Prevalence; D012293:Rifampin; D013019:South Africa / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D013307:Streptomycin; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000453:epidemiology*
D044966:Anti-Retroviral Agents; D007612:Kanamycin; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin