title: Drug-resistant tuberculosis in HIV-infected patients in a national referral hospital, Phnom Penh, Cambodia.
abstract: OBJECTIVE
  There are no recent data on the prevalence of drug-resistant tuberculosis (DR TB) in Cambodia. We aim to describe TB drug resistance amongst adults with pulmonary and extra-pulmonary TB and human immunodeficiency virus (HIV) co-infection in a national referral hospital in Phnom Penh, Cambodia.
  
  
  METHODS
  Between 22 November 2007 and 30 November 2009, clinical specimens from HIV-infected patients suspected of having TB underwent routine microscopy, Mycobacterium tuberculosis culture, and drug susceptibility testing. Laboratory and clinical data were collected for patients with positive M. tuberculosis cultures.
  
  
  RESULTS
  M. tuberculosis was cultured from 236 HIV-infected patients. Resistance to any first-line TB drug occurred in 34.7% of patients; 8.1% had multidrug resistant tuberculosis (MDR TB). The proportion of MDR TB amongst new patients and previously treated patients was 3.7 and 28.9%, respectively (p<0.001). The diagnosis of MDR TB was made after death in 15.8% of patients; in total 26.3% of patients with MDR TB died. The diagnosis of TB was established by culture of extra-pulmonary specimens in 23.6% of cases.
  
  
  CONCLUSIONS
  There is significant resistance to first-line TB drugs amongst new and previously treated TB-HIV co-infected patients in Phnom Penh. These data suggest that the prevalence of DR TB in Cambodia may be higher than previously recognised, particularly amongst HIV-infected patients. Additional prevalence studies are needed. This study also illustrates the feasibility and utility of analysis of non-respiratory specimens in the diagnosis of TB, even in low-resource settings, and suggests that extra-pulmonary specimens should be included in TB diagnostic algorithms.
authors.affiliation: Médecins Sans Frontières (MSF) France, Phnom Penh, Cambodia; Department of Infectious Diseases, Middlemore Hospital, Auckland, New Zealand; genevieve.walls@middlemore.co.nz.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Walls
authors.affiliation: Médecins Sans Frontières (MSF) France, Phnom Penh, Cambodia; AP-HP, Service de Pneumologie, CHU Bicêtre, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bulifon
authors.affiliation: Médecins Sans Frontières (MSF) France, Phnom Penh, Cambodia.
authors.forename: Serge
authors.initials: S
authors.lastname: Breysse
authors.affiliation: Médecins Sans Frontières (MSF) France, Phnom Penh, Cambodia.
authors.forename: Thol
authors.initials: T
authors.lastname: Daneth
authors.affiliation: Epicentre, Paris, France.
authors.forename: Maryline
authors.initials: M
authors.lastname: Bonnet
authors.affiliation: Médecins Sans Frontières (MSF) France, Paris, France.
authors.forename: Northan
authors.initials: N
authors.lastname: Hurtado
authors.affiliation: Médecins Sans Frontières (MSF) France, Phnom Penh, Cambodia.
authors.forename: Lucas
authors.initials: L
authors.lastname: Molfino
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D002160:Cambodia / Q000453:epidemiology; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012959:Socioeconomic Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents
keywords: Cambodia; HIV; drug resistant; tuberculosis