title: Primary drug-resistant tuberculosis in Hanoi, Viet Nam: present status and risk factors.
abstract: BACKGROUND
  Resistance of Mycobacterium tuberculosis (MTB) to anti-tuberculosis (TB) drugs presents a serious challenge to TB control worldwide. We investigated the status of drug resistance, including multidrug-resistant (MDR) TB, and possible risk factors among newly diagnosed TB patients in Hanoi, the capital of Viet Nam.
  
  
  METHODS
  Clinical and epidemiological information was collected from 506 newly diagnosed patients with sputum smear- and culture-positive TB, and 489 (96.6%) MTB isolates were subjected to conventional drug susceptibility testing, spoligotyping, and 15-locus variable numbers of tandem repeats typing. Adjusted odds ratios (aORs) were calculated to analyze the risk factors for primary drug resistance.
  
  
  RESULTS
  Of 489 isolates, 298 (60.9%) were sensitive to all drugs tested. Resistance to isoniazid, rifampicin, streptomycin, ethambutol, and MDR accounted for 28.2%, 4.9%, 28.2%, 2.9%, and 4.5%, respectively. Of 24 isolates with rifampicin resistance, 22 (91.7%) were MDR and also resistant to streptomycin, except one case. Factors associated with isoniazid resistance included living in old urban areas, presence of the Beijing genotype, and clustered strains [aOR = 2.23, 95% confidence interval (CI) 1.15-4.35; 1.91, 1.18-3.10; and 1.69, 1.06-2.69, respectively). The Beijing genotype was also associated with streptomycin resistance (aOR = 2.10, 95% CI 1.29-3.40). Human immunodeficiency virus (HIV) coinfection was associated with rifampicin resistance and MDR (aOR = 5.42, 95% CI 2.07-14.14; 6.23, 2.34-16.58, respectively).
  
  
  CONCLUSIONS
  Isoniazid and streptomycin resistance was observed in more than a quarter of TB patients without treatment history in Hanoi. Transmission of isoniazid-resistant TB among younger people should be carefully monitored in urban areas, where Beijing strains and HIV coinfection are prevalent. Choosing an optimal treatment regimen on the basis of the results of drug susceptibility tests and monitoring of treatment adherence would minimize further development of drug resistance strains.
authors: NCGM-BMH Medical Collaboration Center, Hanoi, Viet Nam.
authors: Nguyen Thi Le
authors: NT
authors: Hang
authors: Shinji
authors: S
authors: Maeda
authors: Luu Thi
authors: LT
authors: Lien
authors: Pham Huu
authors: PH
authors: Thuong
authors: Nguyen Van
authors: NV
authors: Hung
authors: Tran Bich
authors: TB
authors: Thuy
authors: Akiko
authors: A
authors: Nanri
authors: Tetsuya
authors: T
authors: Mizoue
authors: Nguyen Phuong
authors: NP
authors: Hoang
authors: Vu Cao
authors: VC
authors: Cuong
authors: Khieu Thi Thuy
authors: KT
authors: Ngoc
authors: Shinsaku
authors: S
authors: Sakurada
authors: Hiroyoshi
authors: H
authors: Endo
authors: Naoto
authors: N
authors: Keicho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000494:pharmacology*; D060085:Coinfection; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology*; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
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