HIV infection and primary resistance to antituberculosis drugs in Abidjan, Côte dʼIvoire

Mm, Braun; Jo, Kilburn; Rw, Smithwick; Im, Coulibaly; Coulibaly, Daouda; Va, Silcox; Gnaore, E; Adjorlolo, G; Km, De Cock

doi:10.1097/00002030-199211000-00014

Cited by 26 publications

(10 citation statements)

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“…Our model results are broadly consistent with the small number of studies of the individual-level association between HIV and DRTB: there is no clear association in early studies within Sub-Saharan Africa [46–52] as HIV and DRTB were first appearing, whereas in areas with longer, more severe DRTB epidemics (such as Eastern Europe [53–55]), there is a more clear positive association between HIV and DRTB. Our results also support previous observations [19] of a greater positive individual-level association between MDR and HIV for transmitted than for acquired resistance (Figure 4c).…”

Section: Discussionsupporting

confidence: 87%

Modeling the Dynamic Relationship Between HIV and the Risk of Drug-Resistant Tuberculosis

et al. 2012

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The emergence of highly drug-resistant tuberculosis (TB) and interactions between TB and HIV epidemics pose serious challenges for TB control. Previous researchers have presented several hypotheses for why HIV-coinfected TB patients may suffer an increased risk of drug-resistant TB compared to other TB patients. Although some studies have found a positive association between an individual’s HIV status and her subsequent risk of multidrug-resistant TB (MDRTB), the observed individual-level relationship between HIV and drug-resistant TB varies substantially among settings. Here, we develop a modeling framework to explore the effect of HIV on the dynamics of drug-resistant TB. The model captures the acquisition of resistance to important classes of TB drugs, imposes fitness costs associated with resistance-conferring mutations, and allows for subsequent restoration of fitness due to compensatory mutations. Despite uncertainty in several key parameters, we demonstrate epidemic behavior that is robust over a range of assumptions. Whereas HIV facilitates the emergence of MDRTB within a community over several decades, HIV-seropositive individuals presenting with TB may, counter-intuitively, be at lower risk of drug resistant TB at early stages of the co-epidemic. This situation arises because many individuals with incident HIV infection will already harbor latent Mycobacterium Tuberculosis infection acquired at an earlier time when drug-resistance was less prevalent. We find that the rise of HIV can increase the prevalence of MDRTB within populations even as it lowers the average fitness of circulating MDRTB strains compared to similar populations unaffected by HIV. Preferential social mixing among individuals with similar HIV-status and lower average CD4 counts among HIV-seropositive individuals further increase the expected burden of MDRTB. This model suggests that the individual-level association between HIV and drug-resistant forms of TB is dynamic and therefore cross-sectional studies that do not report a positive individual-level association will not provide assurance that HIV does not exacerbate the burden of resistant TB in the community.

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Section: Discussionsupporting

confidence: 87%

Modeling the Dynamic Relationship Between HIV and the Risk of Drug-Resistant Tuberculosis

et al. 2012

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“…In African countries, clustering of MDR-TB among HIV-infected patients in outbreak settings has not been identified as a concern [21,22]. Our discovery of just such an outbreak in South Africa indicates that this may now be one.…”

Section: Discussionmentioning

confidence: 84%

A Comparison of Outbreak‐ and Nonoutbreak‐Related Multidrug‐Resistant Tuberculosis Among Human Immunodeficiency Virus–Infected Patients in a South African Hospital

et al. 1999

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Nosocomial multidrug-resistant tuberculosis (MDR-TB) in human immunodeficiency virus (HIV)-infected people is recognized in Europe and America. We report the first such outbreak in South Africa. Six hospitalized women, identified by DNA fingerprinting, were infected with an outbreak strain of MDR-TB while receiving treatment for drug-susceptible tuberculosis. The putative source case was identified as an HIV-positive woman who underwent prolonged hospitalization for chronic cavitary tuberculosis. Compared with other HIV-positive patients in the hospital, outbreak patients were more immunocompromised, had fewer cavitary lung changes, and were less likely to have been treated before. They had high fevers, infiltrative patterns on chest radiographs, and a mean survival of 43 days. When individual isolation is not possible, separating highly immunocompromised patients with first-time tuberculosis from previously treated patients with cavitary lesions and from those with established drug resistance may reduce nosocomial transmission.

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“…Braun et al undertook one of the first studies of antituberculosis drug resistance and HIV in sub-Saharan Africa [24]. In this small (n = 46) study from Cote d'Ivoire, MDR-TB rates among HIV co-infected (0%) and HIV negative (3.4%) patients were similar.…”

Section: Resultsmentioning

confidence: 96%

Is HIV Infection a Risk Factor for Multi-Drug Resistant Tuberculosis? A Systematic Review

2009

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BackgroundTuberculosis (TB) is an important cause of human suffering and death. Human immunodeficiency virus (HIV), multi-drug resistant TB (MDR-TB), and extensive drug resistant tuberculosis (XDR-TB) have emerged as threats to TB control. The association between MDR-TB and HIV infection has not yet been fully investigated. We conducted a systematic review and meta-analysis to summarize the evidence on the association between HIV infection and MDR-TB.Methods and ResultsOriginal studies providing Mycobacterium tuberculosis resistance data stratified by HIV status were identified using MEDLINE and ISI Web of Science. Crude MDR-TB prevalence ratios were calculated and analyzed by type of TB (primary or acquired), region and study period. Heterogeneity across studies was assessed, and pooled prevalence ratios were generated if appropriate. No clear association was found between MDR-TB and HIV infection across time and geographic locations. MDR-TB prevalence ratios in the 32 eligible studies, comparing MDR-TB prevalence by HIV status, ranged from 0.21 to 41.45. Assessment by geographical region or study period did not reveal noticeable patterns. The summary prevalence ratios for acquired and primary MDR-TB were 1.17 (95% CI 0.86, 1.6) and 2.72 (95% CI 2.03, 3.66), respectively. Studies eligible for review were few considering the size of the epidemics. Most studies were not adjusted for confounders and the heterogeneity across studies precluded the calculation of a meaningful overall summary measure.ConclusionsWe could not demonstrate an overall association between MDR-TB and HIV or acquired MDR-TB and HIV, but our results suggest that HIV infection is associated with primary MDR-TB. Future well-designed studies and surveillance in all regions of the world are needed to better clarify the relationship between HIV infection and MDR-TB.

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HIV infection and primary resistance to antituberculosis drugs in Abidjan, Côte dʼIvoire

Cited by 26 publications

References 0 publications

Modeling the Dynamic Relationship Between HIV and the Risk of Drug-Resistant Tuberculosis

Modeling the Dynamic Relationship Between HIV and the Risk of Drug-Resistant Tuberculosis

A Comparison of Outbreak‐ and Nonoutbreak‐Related Multidrug‐Resistant Tuberculosis Among Human Immunodeficiency Virus–Infected Patients in a South African Hospital

Is HIV Infection a Risk Factor for Multi-Drug Resistant Tuberculosis? A Systematic Review

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