Alarming Levels of Drug-Resistant Tuberculosis in HIV-Infected Patients in Metropolitan Mumbai, India

作者：Petros Isaakidis, Mrinalini Das, Ajay Kumar, Christopher Peskett, Minni Khetarpal, Arun Bamne, Balkrishna Adsul, Mamta Manglani, Kuldeep Singh Sachdeva, Malik Parmar, Avinash Kanchar, B. B. Rewari, Alaka Deshpande, Camilla Rodrigues, Anjali Shetty, Lorraine Rebello, Peter Saranchuk · 发表于：PLoS ONE · 年份：2014 · DOI：10.1371/journal.pone.0110461 · 被引用次数：65 · 研究领域：Tuberculosis Research and Epidemiology、Diverse Scientific Research Studies、Pneumocystis jirovecii pneumonia detection and treatment

BACKGROUND: Drug-resistant tuberculosis (DR-TB) is a looming threat to tuberculosis control in India. However, no countrywide prevalence data are available. The burden of DR-TB in HIV-co-infected patients is likewise unknown. Undiagnosed and untreated DR-TB among HIV-infected patients is a major cause of mortality and morbidity. We aimed to assess the prevalence of DR-TB (defined as resistance to any anti-TB drug) in patients attending public antiretroviral treatment (ART) centers in greater metropolitan Mumbai, India. METHODS: A cross-sectional survey was conducted among adults and children ART-center attendees. Smear microscopy, culture and drug-susceptibility-testing (DST) against all first and second-line TB-drugs using phenotypic liquid culture (MGIT) were conducted on all presumptive tuberculosis patients. Analyses were performed to determine DR-TB prevalence and resistance patterns separately for new and previously treated, culture-positive TB-cases. RESULTS: Between March 2013 and January 2014, ART-center attendees were screened during 14135 visits, of whom 1724 had presumptive TB. Of 1724 attendees, 72 (4%) were smear-positive and 202 (12%) had a positive culture for Mycobacterium tuberculosis. Overall DR-TB was diagnosed in 68 (34%, 95% CI: 27%-40%) TB-patients. The proportions of DR-TB were 25% (29/114) and 44% (39/88) among new and previously treated cases respectively. The patterns of DR-TB were: 21% mono-resistant, 12% poly-resistant, 38% multidrug-resistant (MD...