Volume 13 Supplement 1
Human immunodeficiency virus coinfection with drug-resistant Mycobacterium tuberculosis
© Zaharia-Kézdi et al; licensee BioMed Central Ltd. 2013
Published: 16 December 2013
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.
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.
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).
The incidence of HIV-TB-R is increasing with long hospitalization periods, difficult therapy, low adherence and high mortality rate.
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.