Consultant Biostatistician, Poona Hospital and Research Center, Pune, India.
Institute of Infectious Diseases, Pune, India.
BMC Infect Dis. 2019 May 8;19(1):391. doi: 10.1186/s12879-019-4042-z.
Most studies assessing drug resistant tuberculosis (DRTB) in human immunodeficiency virus (HIV) co-infected patients in India have used conventional culture- based systems to diagnose DRTB that have a longer turnaround time leading to risk of amplification of resistance to an empirical regimen. We determined the prevalence of DRTB amongst people living with HIV (PLHIV) using the line probe assay and determined risk factors associated with the presence of multi drug resistant tuberculosis (MDRTB).
A Cross-sectional study was undertaken at Poona Hospital and Research Center (PHRC) and the Institute of Infectious Diseases, two tertiary level private care centers in Pune, India. Consenting PLHIV with confirmed Pulmonary TB (PTB) and/or extra-pulmonary TB (EPTB) diagnosed based on detection of Mycobacterium TB by line probe assay (Geno Type MTBDRplus version 2) on clinical specimens were included. Those with documented past history of DRTB were excluded. Resistance against anti-TB drugs was determined by the same assay. The prevalence of any form of drug resistant TB (DRTB), MDRTB, Rifampicin resistant TB (RRTB) and Isoniazid (INH) mono-resistant TB were determined as the proportion of these amongst all included PLHIV-TB. A multivariate analysis was conducted to determine risk factors that were statistically associated with MDRTB, DRTB, RRTB and INH mono-resistant TB.
Two hundred PLHIV were recruited. The prevalence (95% CI) of MDRTB, INH mono- resistance and RR resistance was 12.5% (7.9-17.1%), 9% (6.9-11.2%) and 2.5% (1.4-3.6%), respectively. The prevalence (95% CI) of MDRTB among new and relapsed patients was 8.8% (6.5-11.1%) and 23.1% (17.2-28.9%), respectively. Tuberculosis relapse was the only factor significantly associated with MDRTB, DRTB and INH mono-resistant TB.
We document a high prevalence of drug resistance to anti-TB drugs including MDRTB among PLHIV in our setting using Geno Type MTBDRplus directly on clinical specimens. This validates the WHO recommendation of performing routine rapid molecular resistance testing prior to initiating anti-TB treatment among all PLHIV with presumptive TB. Using rapid molecular testing especially Geno Type MTBDRplus (that detects resistance to INH and Rifampicin simultaneously) reduces the turn-around time helping in optimizing treatment.
在印度，大多数评估人类免疫缺陷病毒（HIV）合并感染患者耐药性结核病（DRTB）的研究都使用传统的培养为基础的系统来诊断 DRTB，这种方法的检测时间较长，导致经验性治疗方案中耐药性扩增的风险增加。我们使用线探针分析（LPA）来确定 HIV 感染者（PLHIV）中 DRTB 的患病率，并确定与耐多药结核病（MDRTB）存在相关的危险因素。
在浦那医院和研究中心（PHRC）和传染病研究所进行了一项横断面研究，这是印度浦那的两个三级私人护理中心。纳入符合条件的 PLHIV 有确诊的肺结核（PTB）和/或肺外结核（EPTB），这些疾病是基于临床标本中分枝杆菌的 LPA（Geno Type MTBDRplus 版本 2）检测结果来诊断的。那些有记录的过去 DRTB 病史的患者被排除在外。通过相同的检测方法来确定对抗结核药物的耐药性。通过这些方法在所有纳入的 PLHIV-TB 中确定任何形式的耐药性结核病（DRTB）、MDRTB、利福平耐药性结核病（RRTB）和异烟肼（INH）单耐药性结核病的患病率。采用多变量分析确定与 MDRTB、DRTB、RRTB 和 INH 单耐药性结核病具有统计学关联的危险因素。
共招募了 200 名 PLHIV。MDRTB、INH 单耐药和 RR 耐药的患病率（95%CI）分别为 12.5%（7.9-17.1%）、9%（6.9-11.2%）和 2.5%（1.4-3.6%）。新发和复发患者的 MDRTB 患病率（95%CI）分别为 8.8%（6.5-11.1%）和 23.1%（17.2-28.9%）。结核病复发是唯一与 MDRTB、DRTB 和 INH 单耐药性结核病显著相关的因素。
我们使用 Geno Type MTBDRplus 直接在临床标本上对 HIV 感染者进行检测，发现了对包括 MDRTB 在内的抗结核药物的耐药率很高。这验证了世界卫生组织（WHO）的建议，即在所有疑似结核病的 PLHIV 中，在开始抗结核治疗之前，应常规进行快速分子耐药检测。使用快速分子检测，特别是 Geno Type MTBDRplus（同时检测 INH 和利福平的耐药性），可以缩短检测时间，帮助优化治疗。
