title: Converging risk factors but no association between HIV infection and multidrug-resistant tuberculosis in Kazakhstan.
abstract: METHODS
  Kazakhstan is a country with a low HIV/AIDS (human immunodeficiency virus/acquired immune-deficiency syndrome) burden, but a high prevalence of multidrug-resistant tuberculosis (MDR-TB).
  
  
  METHODS
  We describe the epidemiology of multidrug resistance and HIV among TB patients, using the 2007-2011 national electronic TB register.
  
  
  RESULTS
  HIV test results were available for 97.2% of TB patients. HIV prevalence among TB patients increased from 0.6% in 2007 to 1.5% in 2011. Overall, 41.6% of patients had a positive smear at diagnosis, 38.6% a positive culture and 51.7% either a positive smear or culture. Drug susceptibility testing (DST) results were available for 92.7% of culture-positive cases. Socio-economic factors independently associated with both HIV and MDR-TB were urban residency, drug use, homelessness and a history of incarceration. In adjusted analysis, HIV positivity was not associated with MDR-TB (OR 1.0, 95%CI 0.86-1.2). Overall, among TB patients with DST and HIV test results available, 65.0% were positive for neither HIV nor MDR-TB, 33.5% only for MDR-TB, 0.9% only for HIV and 0.6% for both HIV and MDR-TB. Among injection drug users, 12.5% were positive for HIV and MDR-TB.
  
  
  CONCLUSIONS
  We showed increasing HIV prevalence among TB patients in Kazakhstan. HIV was not an independent risk factor for MDR-TB, but risk factors were largely overlapping and we did identify subgroups at particular risk of HIV-MDR-TB co-infection, notably drug users. Enhanced efforts are necessary to provide care to these socially vulnerable populations.
authors.affiliation: KNCV Tuberculosis Foundation, The Hague, The Netherlands. vandenhofs@kncvtbc.nl
authors.forename: S
authors.initials: S
authors.lastname: van den Hof
authors.forename: A
authors.initials: A
authors.lastname: Tursynbayeva
authors.forename: T
authors.initials: T
authors.lastname: Abildaev
authors.forename: M
authors.initials: M
authors.lastname: Adenov
authors.forename: S
authors.initials: S
authors.lastname: Pak
authors.forename: G
authors.initials: G
authors.lastname: Bekembayeva
authors.forename: S
authors.initials: S
authors.lastname: Ismailov
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D055030:Drug Users / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007623:Kazakhstan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D013997:Time Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D035862:Vulnerable Populations / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents