Burnet Institute, Melbourne, Australia.
PLoS One. 2010 Nov 15;5(11):e13901. doi: 10.1371/journal.pone.0013901.
Although multidrug-resistant tuberculosis (MDR-TB) is emerging as a significant threat to tuberculosis control in high HIV prevalence countries such as South Africa, limited data is available on the burden of drug resistant tuberculosis and any association with HIV in such settings. We conducted a community-based representative survey to assess the MDR-TB burden in Khayelitsha, an urban township in South Africa with high HIV and TB prevalence.
METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional survey was conducted among adult clinic attendees suspected for pulmonary tuberculosis in two large primary care clinics, together constituting 50% of the tuberculosis burden in Khayelitsha. Drug susceptibility testing (DST) for isoniazid and rifampicin was conducted using a line probe assay on positive sputum cultures, and with culture-based DST for first and second-line drugs. Between May and November 2008, culture positive pulmonary tuberculosis was diagnosed in 271 new and 264 previously treated tuberculosis suspects (sample enriched with previously treated cases). Among those with known HIV status, 55% and 71% were HIV infected respectively. MDR-TB was diagnosed in 3.3% and 7.7% of new and previously treated cases. These figures equate to an estimated case notification rate for MDR-TB of 51/100,000/year, with new cases constituting 55% of the estimated MDR-TB burden. HIV infection was not significantly associated with rifampicin resistance in multivariate analyses.
CONCLUSIONS/SIGNIFICANCE: There is an extremely high burden of MDR-TB in this setting, most likely representing ongoing transmission. These data highlight the need to diagnose drug resistance among all TB cases, and for innovative models of case detection and treatment for MDR-TB, in order to interrupt transmission and control this emerging epidemic.
尽管耐多药结核病（MDR-TB）在南非等高艾滋病毒流行国家对结核病控制构成了重大威胁，但在这些环境中，关于耐药结核病的负担以及与艾滋病毒的任何关联的可用数据有限。我们进行了一项基于社区的代表性调查，以评估南非城市郊区 Khayelitsha 的 MDR-TB 负担，该地区艾滋病毒和结核病的患病率都很高。
方法/主要发现：在两个大型初级保健诊所中，对疑似患有肺结核的成年门诊患者进行了横断面调查，这两个诊所共同构成了 Khayelitsha 结核病负担的 50%。对阳性痰培养物进行了线探针分析（LPA）以检测异烟肼和利福平的药物敏感性测试（DST），并对一线和二线药物进行了基于培养的 DST。2008 年 5 月至 11 月期间，在 271 例新发病例和 264 例既往治疗的结核病疑似病例（经治疗病例丰富）中诊断出培养阳性肺结核。在已知 HIV 状况的人群中，分别有 55%和 71%的人感染了 HIV。在新发病例和既往治疗病例中，分别诊断出 3.3%和 7.7%的 MDR-TB。这些数字相当于每年每 100,000 人中 51 例 MDR-TB 的估计病例报告率，新发病例构成了估计的 MDR-TB 负担的 55%。在多变量分析中，HIV 感染与利福平耐药没有显著关联。
结论/意义：在这种情况下，MDR-TB 的负担极高，很可能代表正在进行的传播。这些数据强调需要在所有结核病病例中诊断药物耐药性，并需要创新的病例发现和 MDR-TB 治疗模式，以中断传播并控制这一新兴的流行。
