Opolot Godfrey, Olupot-Olupot Peter, Okware Samuel, Izudi Jonathan
Department of Community and Public Health, Busitema University, Uganda.
Uganda National Health Research Organization, Kampala, Uganda.
J Clin Tuberc Other Mycobact Dis. 2025 Sep 12;41:100562. doi: 10.1016/j.jctube.2025.100562. eCollection 2025 Dec.
People with human immunodeficiency virus (PWH) have an increased risk of multidrug-resistant TB (MDR-TB) compared to those without HIV.
To investigate the risk factors for MDR-TB among PWH in rural eastern Uganda.
We conducted a nested case-control study at Soroti Regional Referral Hospital in rural eastern Uganda. TB records from January 2017 to May 2024 were retrospectively reviewed to identify all PWH. MDR-TB was defined as resistance to at least both Isoniazid and Rifampicin following GeneXpert and Rifampicin assay and culture-based drug-susceptible testing. Cases were PWH with MDR-TB, while controls were a random sample of PWH without MDR-TB, in a 1:3 ratio. Multivariable binary logistic regression was used to identify factors independently associated with being a case rather than a control. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported.
We included 37 cases and 111 controls, and found retreatment TB was associated with being a case rather than a control (aOR 6.97; 95% CI 2.65-19.46). Male sex (aOR: 1.59; 95% CI: 0.67-3.93), clinically diagnosed pulmonary TB (aOR: 0.38; 95% CI: 0.10-1.23) or extrapulmonary TB (aOR: 0.37; 95% CI: 0.05-1.62), and recent anti-retroviral therapy initiation (aOR: 2.07; 95% CI: 0.83-5.28) were insignificantly associated with being a case.
This study showed that retreatment TB is associated with a higher likelihood of MDR-TB among PWH in a referral hospital in rural eastern Uganda. These findings underscore the need for intensified drug resistance surveillance and adherence support among PWH with prior TB treatment.
与未感染艾滋病毒的人相比，感染人类免疫缺陷病毒（HIV）的人发生耐多药结核病（MDR-TB）的风险更高。
调查乌干达东部农村地区感染HIV的人发生MDR-TB的危险因素。
我们在乌干达东部农村的索罗蒂地区转诊医院开展了一项巢式病例对照研究。回顾性查阅2017年1月至2024年5月的结核病记录，以确定所有感染HIV的人。MDR-TB的定义为在GeneXpert检测以及利福平检测和基于培养的药敏试验后，至少对异烟肼和利福平均耐药。病例为患有MDR-TB的感染HIV的人，对照为未患MDR-TB的感染HIV的人的随机样本，比例为1:3。采用多变量二元逻辑回归分析来确定与成为病例而非对照独立相关的因素。报告调整后的比值比（aOR）和95%置信区间（CI）。
我们纳入了37例病例和111例对照，发现复治结核病与成为病例而非对照相关（aOR 6.97；95% CI 2.65-19.46）。男性（aOR：1.59；95% CI：0.67-3.93）、临床诊断的肺结核（aOR：0.38；95% CI：0.10-1.23）或肺外结核（aOR：0.37；95% CI：0.05-1.62）以及近期开始抗逆转录病毒治疗（aOR：2.07；95% CI：0.83-5.28）与成为病例的相关性不显著。
本研究表明，在乌干达东部农村的一家转诊医院中，复治结核病与感染HIV的人发生MDR-TB的可能性较高相关。这些发现强调了对接受过结核病治疗的感染HIV的人加强耐药监测和依从性支持的必要性。
