Volume 13 Supplement 1

Proceedings of the 9th Edition of the Scientific Days of the National Institute for Infectious Diseases “Prof Dr Matei Bals”

Open Access

Human immunodeficiency virus coinfection with drug-resistant Mycobacterium tuberculosis

  • Iringó Erzsébet Zaharia-Kézdi1Email author,
  • Carmen Chiriac1,
  • Andrea Incze1,
  • Nina Șincu1,
  • Lilla Lorinczi2 and
  • Mihaela Patraulea3
BMC Infectious Diseases201313(Suppl 1):O8

https://doi.org/10.1186/1471-2334-13-S1-O8

Published: 16 December 2013

Background

Tuberculosis (TB), one of the oldest infectious diseases known to mankind, is a major cause of death for human immunodeficiency virus (HIV) infected people. Since 2008, the HIV/AIDS Mureş Regional Centre has been monitoring the increase in cases of HIV-TB with drug-resistant mycobacteria (MTB). We have decided to analyze particular aspects of this phenomenon.

Methods

Retrospective cross-sectional study performed in the Infectious Diseases Clinic I Tîrgu Mureş during the period of 2008-2012. The study included HIV positive patients diagnosed with drug-resistant tuberculosis (TB-R). We monitored epidemiological and clinical data as well as the evolution of the disease. We compared the results with those of patients diagnosed during the period of 2003-2012 with HIV-drug-sensitive TB (TB-nR). For statistical analysis we used the Fisher and T tests.

Results

83 patients were diagnosed with HIV-TB-nR with an average age of 23 years. 36 were without antiretroviral therapy (ART), with a CD4 count of 198 cells/µL; 73% were adherent to ART, 32% have deceased. 25 patients were diagnosed with HIV-TB-R (with an average age 25.6 years, over 50% were male) 7 of which were MDR, 11 pre-XDR, 7 XDR. Most cases of HIV TB-R were recorded in 2011, (8 cases of which 2 MDR, 6 pre-XDR). The patients suffered predominantly from secondary pulmonary TB (22) but also from extra pulmonary TB like meningoencephalitis (8). Resistance to isoniazid and rifampin was 100% (MDR), resistance to ethambutol 66.97%, 62.96% to streptomycin, 33.33% to kanamycin, 55.56% to quinolones. All strains maintained their sensitivity towards ethionamide, cycloserine, para-aminosalicylic acid. Hospitalization periods for patients with MDR were significantly longer (68 days) than those of patients without MDR (44 days): T test p=0.0045. The adherence to ART of TB-R patients was much lower than that of TB-nR patients (odds ratio 2.12, Fisher test p=0.04). We have not found significant statistical difference between CD4 lymphocyte numbers in MDR (140 cells/µL) and non-MDR patients. Drug-resistance has had significant statistical influence over the mortality rate of patients (odds ratio, 3.11, Fisher test p=0.019).

Conclusion

The incidence of HIV-TB-R is increasing with long hospitalization periods, difficult therapy, low adherence and high mortality rate.

Authors’ Affiliations

(1)
Infectious Diseases Clinic I, University of Medicine and Pharmacy Tîrgu Mureş
(2)
Department of Pneumophthisiology, University of Medicine and Pharmacy Tîrgu Mureş
(3)
Clinic of Pneumophtisiology, County Hospital Mureş

Copyright

© Zaharia-Kézdi et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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