Detection of a Substantial Rate of Multidrug-Resistant Tuberculosis in an HIV-Infected Population in South Africa by Active Monitoring of Sputum Samples

作者：Hassim Shaheen; Shaw Pamela A; Sangweni Phumelele; Malan Lizette; Ntshani Ella; Mathibedi Monkwe Jethro; Stubbs Nomso; Metcalf Julia A; Eckes Risa; Masur Henry^*; Komati Stephanus

来源：Clinical Infectious Diseases, 2010, 50(7): 1053-1059.

DOI：10.1086/651119

Background. Tuberculosis (TB) coinfection with human immunodeficiency virus (HIV) is a substantial problem in South Africa. There has been a presumption that drug-resistant strains of TB are common in South Africa, but few studies have documented this impression.
Methods. In Phidisa, a joint observational and randomized HIV treatment study for South African National Defence Force members and dependents, an initiative was launched to test subjects ( by use of microbiologic TB test) who appeared to be at high risk. We report results for HIV-infected subjects.
Results. TB was identified by culture in 116 (19.9%) of 584 patients selected for sputum examination on the basis of suggestive symptoms. Smear was an insensitive technique for confirming the diagnosis: only 33% of culture-positive patients were identified by smear, with a 0.2% false-positive rate. Of the 107 culture-positive individuals with susceptibility testing, 22 (20.6%) were identified to be multidrug resistant (MDR), and 4 (3.7%) were identified to be extensively drug resistant. Culture-positive cases with a history of TB treatment had more than twice the rate of MDR than those without (27.1% vs 11.9%; P = .05).
Conclusions. TB is common in this cohort of HIV-infected patients. Smear was not a sensitive technique for identifying culture-positive cases in this health system. Drug susceptibility testing is essential to proper patient management because MDR was present in 20.6% of culture-positive patients. Better management strategies are needed to reduce the development of MDR TB, because so many of these patients had received prior antituberculous therapy that was presumably not curative.

• 出版日期2010-4-1