25% of HIV patients detected with primary drug-resistant TB

Epidemic may be driven by primary transmission rather than irregular TB treatment, say doctors

An alarming 25% of Human Immunodeficiency Virus (HIV) patients from the city detected with drug-resistant tuberculosis (DR-TB) were primarily infected with the resistant form of TB bacteria which does not respond to the known anti-TB drugs. The findings were part of a new study released by international medical humanitarian organisation Médecins Sans Frontières (MSF).

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The study, published in PLoS One, an international journal, is the first to measure the burden of drug resistant TB infection in high HIV-burden settings in the city.

MSF said the study was conducted between February 2013 and January 2014 at seven Anti-Retroviral Treatment centres in Mumbai. Researchers collected sputum of 1,724 patients with TB symptoms. The study reveals the proportion of DR-TB to be 25% among new cases of TB and 44% among previously treated TB cases.

According to Dr Petros Isaakidis, MSF principal investigator of the study, the DR-TB epidemic may be driven by primary transmission rather than the lack of adherence to TB treatment.

“Such studies will help shape the national response with specific interventions for those populations most at risk of getting DR-TB,” said Dr Arun Bamne, co-author of the study and former executive health officer of Mumbai’s public health department.

Conventionally, patients, who opt out of anti-TB treatment, develop resistance to the known TB drugs and are classified DR-TB cases. However, with the increase in the number of such cases, many healthy individuals are primarily contracting the resistant strain, making it challenging to treat them.

“Lifetime risk in getting TB in immune-compromised patients such as HIV is 8% to 10 %. There is a very strong association between TB and HIV and so the burden of TB in HIV patients is always high. TB is a global epidemic and the rise of primary drug resistance should be addressed,” said Dr Om Shrivastav, director, infectious diseases department, Jaslok Hospital, Peddar Road.