title: Rifampin monoresistant tuberculosis and HIV comorbidity in California, 1993-2008: a retrospective cohort study.
abstract: OBJECTIVE
  Rifampin monoresistant tuberculosis (RMR-TB) is increasingly identified because of scale-up of rapid molecular tests. The longitudinal association of RMR-TB, multidrug-resistant TB (MDR-TB), and HIV/AIDS is incompletely described.
  
  
  METHODS
  We examined clinical characteristics and treatment outcomes of patients with RMR-TB, isoniazid monoresistant TB (IMR-TB), MDR-TB, and drug-susceptible TB during a 16-year period (1993-2008) in California. TB cases were cross-matched with the state HIV/AIDS registry, and HIV prevalence denominators modeled using nonparametric backcalculation.
  
  
  RESULTS
  Of 42,582 TB cases, 178 (0.4%), 3469 (8.1%), and 635 (1.5%) were RMR-TB, IMR-TB, and MDR-TB, respectively. From the pre-HAART (1993-1996) to HAART (2005-2008) era, RMR-TB rates declined rapidly (12.0 vs. 0.5 per 100,000) among patients with HIV infection. The proportion of patients for whom rifampin resistance indicated RMR-TB (rather than MDR-TB) decreased from 31% [95% confidence interval (CI) 26-38%] to 11% (95% CI 5-19%). In multivariate analysis controlling for HIV coinfection and other covariates, patients with RMR-TB were twice as likely to die as patients with drug-sensitive TB (relative risk 1.94, 95% CI 1.40-2.69).
  
  
  CONCLUSIONS
  RMR-TB/HIV rates declined substantially over time in association with improved TB control and HIV control in California. Mortality among patients with RMR-TB was high, even after adjusting for HIV status.
authors.affiliation: aCenter for AIDS Prevention Studies (CAPS), University of California, San Francisco bTuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond cF.I. Proctor Foundation, University of California, San Francisco dCurry International Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Prach
authors.forename: Lisa
authors.initials: L
authors.lastname: Pascopella
authors.forename: Pennan M
authors.initials: PM
authors.lastname: Barry
authors.forename: Jennifer
authors.initials: J
authors.lastname: Flood
authors.forename: Travis C
authors.initials: TC
authors.lastname: Porco
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hopewell
authors.forename: John Z
authors.initials: JZ
authors.lastname: Metcalfe
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000494:pharmacology*; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D024881:Drug Resistance, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007538:Isoniazid / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D015995:Prevalence; D012189:Retrospective Studies; D012293:Rifampin / Q000494:pharmacology*; D016019:Survival Analysis; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000453:epidemiology*
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin