HIV infection and multidrug-resistant tuberculosis: the perfect storm

Multidrug-resistant (MDR) tuberculosis (TB) has emerged as a global epidemic, with ~425,000 new cases estimated to occur annually. The global human immunodeficiency virus (HIV) infection epidemic has caused explosive increases in TB incidence and may be contributing to increases in MDR-TB prevalence...

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Bibliographic Details
Published in:The Journal of infectious diseases Vol. 196 Suppl 1; p. S86
Main Authors: Wells, Charles D, Cegielski, J Peter, Nelson, Lisa J, Laserson, Kayla F, Holtz, Timothy H, Finlay, Alyssa, Castro, Kenneth G, Weyer, Karin
Format: Journal Article
Language:English
Published: United States 15.08.2007
Subjects:
Adolescent
Adult
Anti-HIV Agents - therapeutic use
Antitubercular Agents - metabolism
Antitubercular Agents - pharmacology
Antitubercular Agents - therapeutic use
Disease Outbreaks
Drug Resistance, Multiple, Bacterial
Drug Therapy, Combination
Global Health
HIV
HIV Infections - complications
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - mortality
Humans
Malabsorption Syndromes
Middle Aged
Mycobacterium tuberculosis - drug effects
Prevalence
Rifamycins - pharmacology
Risk Factors
Sentinel Surveillance
Treatment Outcome
Tuberculosis - complications
Tuberculosis - drug therapy
Tuberculosis - epidemiology
Tuberculosis - microbiology
Tuberculosis - mortality
ISSN:0022-1899
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Summary:Multidrug-resistant (MDR) tuberculosis (TB) has emerged as a global epidemic, with ~425,000 new cases estimated to occur annually. The global human immunodeficiency virus (HIV) infection epidemic has caused explosive increases in TB incidence and may be contributing to increases in MDR-TB prevalence. We reviewed published studies and available surveillance data evaluating links between HIV infection and MDR-TB to quantify convergence of these 2 epidemics, evaluate the consequences, and determine essential steps to address these epidemics. Institutional outbreaks of MDR-TB have primarily affected HIV-infected persons. Delayed diagnosis, inadequate initial treatment, and prolonged infectiousness led to extraordinary attack rates and case-fatality rates among HIV-infected persons. Whether this sequence occurs in communities is less clear. MDR-TB appears not to cause infection or disease more readily than drug-susceptible TB in HIV-infected persons. HIV infection may lead to malabsorption of anti-TB drugs and acquired rifamycin resistance. HIV-infected patients with MDR-TB have unacceptably high mortality; both antiretroviral and antimycobacterial treatment are necessary. Simultaneous treatment requires 6-10 different drugs. In HIV-prevalent countries, TB programs struggle with increased caseloads, which increase the risk of acquired MDR-TB. Surveillance data suggest that HIV infection and MDR-TB may converge in several countries. Institutional outbreaks, overwhelmed public health programs, and complex clinical management issues may contribute to the convergence of the MDR-TB and HIV infection epidemics. To forestall disastrous consequences, infection control, rapid case detection, effective treatment, and expanded program capacity are needed urgently.
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ISSN:0022-1899
DOI:10.1086/518665