Alarming levels of drug-resistant tuberculosis in HIV-infected patients in metropolitan Mumbai, India.
<h4>Background</h4>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 pati...
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oai:doaj.org-article:9b180a4bdd8642e8bffbb36844b24ca72021-11-25T05:55:46ZAlarming levels of drug-resistant tuberculosis in HIV-infected patients in metropolitan Mumbai, India.1932-620310.1371/journal.pone.0110461https://doaj.org/article/9b180a4bdd8642e8bffbb36844b24ca72014-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0110461https://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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 (MDR-TB), 21% pre-extensively-drug-resistant (MDR-TB plus resistance to either a fluoroquinolone or second-line injectable), 6% extensively drug-resistant (XDR-TB) and 2% extremely drug-resistant TB (XDR-TB plus resistance to any group-IV/V drug). Only previous history of TB was significantly associated with the diagnosis of DR-TB in multivariate models.<h4>Conclusion</h4>The burden of DR-TB among HIV-infected patients attending public ART-centers in Mumbai was alarmingly high, likely representing ongoing transmission in the community and health facilities. These data highlight the need to promptly diagnose drug-resistance among all HIV-infected patients by systematically offering access to first and second-line DST to all patients with 'presumptive TB' rather than 'presumptive DR-TB' and tailor the treatment regimen based on the resistance patterns.Petros IsaakidisMrinalini DasAjay M V KumarChristopher PeskettMinni KhetarpalArun BamneBalkrishna AdsulMamta ManglaniKuldeep Singh SachdevaMalik ParmarAvinash KancharB B RewariAlaka DeshpandeCamilla RodriguesAnjali ShettyLorraine RebelloPeter SaranchukPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 10, p e110461 (2014) |
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Medicine R Science Q Petros Isaakidis Mrinalini Das Ajay M V 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 Alarming levels of drug-resistant tuberculosis in HIV-infected patients in metropolitan Mumbai, India. |
| description |
<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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 (MDR-TB), 21% pre-extensively-drug-resistant (MDR-TB plus resistance to either a fluoroquinolone or second-line injectable), 6% extensively drug-resistant (XDR-TB) and 2% extremely drug-resistant TB (XDR-TB plus resistance to any group-IV/V drug). Only previous history of TB was significantly associated with the diagnosis of DR-TB in multivariate models.<h4>Conclusion</h4>The burden of DR-TB among HIV-infected patients attending public ART-centers in Mumbai was alarmingly high, likely representing ongoing transmission in the community and health facilities. These data highlight the need to promptly diagnose drug-resistance among all HIV-infected patients by systematically offering access to first and second-line DST to all patients with 'presumptive TB' rather than 'presumptive DR-TB' and tailor the treatment regimen based on the resistance patterns. |
| format |
article |
| author |
Petros Isaakidis Mrinalini Das Ajay M V 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 |
| author_facet |
Petros Isaakidis Mrinalini Das Ajay M V 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 |
| author_sort |
Petros Isaakidis |
| title |
Alarming levels of drug-resistant tuberculosis in HIV-infected patients in metropolitan Mumbai, India. |
| title_short |
Alarming levels of drug-resistant tuberculosis in HIV-infected patients in metropolitan Mumbai, India. |
| title_full |
Alarming levels of drug-resistant tuberculosis in HIV-infected patients in metropolitan Mumbai, India. |
| title_fullStr |
Alarming levels of drug-resistant tuberculosis in HIV-infected patients in metropolitan Mumbai, India. |
| title_full_unstemmed |
Alarming levels of drug-resistant tuberculosis in HIV-infected patients in metropolitan Mumbai, India. |
| title_sort |
alarming levels of drug-resistant tuberculosis in hiv-infected patients in metropolitan mumbai, india. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2014 |
| url |
https://doaj.org/article/9b180a4bdd8642e8bffbb36844b24ca7 |
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