The impact of human immunodeficiency virus infection on drug-resistant tuberculosis

Infection with human immunodeficiency virus (HIV) has been associated with increased rates of single- and multidrug-resistant (MDR) tuberculosis in the New York City area. In order to examine the relationship of HIV infection to drug-resistant tuberculosis in other selected regions of the United Sta...

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Bibliographic Details
Published in:	American journal of respiratory and critical care medicine Vol. 154; no. 5; p. 1478
Main Authors:	Gordin, F M, Nelson, E T, Matts, J P, Cohn, D L, Ernst, J, Benator, D, Besch, C L, Crane, L R, Sampson, J H, Bragg, P S, El-Sadr, W
Format:	Journal Article
Language:	English
Published:	United States 01-11-1996
Subjects:	Adolescent Adult Antitubercular Agents - therapeutic use Clinical Trials as Topic Female HIV Infections - complications Homeless Persons Homosexuality Humans Male Middle Aged New York City - epidemiology Prevalence Registries Tuberculosis, Multidrug-Resistant - epidemiology Tuberculosis, Multidrug-Resistant - etiology Tuberculosis, Pulmonary - prevention & control United States - epidemiology Urban Population New York City United States
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Summary:	Infection with human immunodeficiency virus (HIV) has been associated with increased rates of single- and multidrug-resistant (MDR) tuberculosis in the New York City area. In order to examine the relationship of HIV infection to drug-resistant tuberculosis in other selected regions of the United States, we established a registry of cases of culture-proven tuberculosis. Data were collected from sites participating in an NIH-funded, community-based HIV clinical trials group. All cases of tuberculosis, regardless of HIV status, which occurred between January 1992 and June 1994 were recorded. Overall, 1,373 cases of tuberculosis were evaluated, including 425 from the New York City area, and 948 from seven other metropolitan areas. The overall prevalence of resistance to one or more drugs was 20.4%, and 5.6% of isolates were resistant to both isoniazid and rifampin (MDR). In the New York City area, HIV-infected patients were significantly more likely than persons not known to be HIV-infected, to have resistance to at least one drug (37% versus 19%) and MDR (19% versus 6%). In other geographic areas, overall drug resistance was 16%, and only 2.2% of isolates were MDR. In multiple logistic regression analyses, HIV infection was shown to be a risk factor for drug-resistant tuberculosis, independent of geographic location, history of prior therapy, age, and race. We concluded that HIV infection is associated with increased rates of resistance to antituberculosis drugs in both the New York City area and other geographic areas. MDR tuberculosis is occurring predominantly in the New York City area and is highly correlated with HIV infection.
ISSN:	1073-449X
DOI:	10.1164/ajrccm.154.5.8912768