%0 Journal Article
%T Drug-Resistant Tuberculosis among HIV-Infected Patients Starting Antiretroviral Therapy in Durban, South Africa
%A Jeffrey K. Hom
%A Bingxia Wang
%A Senica Chetty
%A Janet Giddy
%A Matilda Mazibuko
%A Jenny Allen
%A Rochelle P. Walensky
%A Elena Losina
%A Kenneth A. Freedberg
%A Ingrid V. Bassett
%J PLOS ONE
%D 2012
%I Public Library of Science (PLoS)
%R 10.1371/journal.pone.0043281
%X Objective To estimate the prevalence of drug-resistant tuberculosis (TB) and describe the resistance patterns in patients commencing antiretroviral therapy (ART) in an HIV clinic in Durban, South Africa. Design Cross-sectional cohort study. Methods Consecutive HIV-infected adults (≡18y/o) initiating HIV care were enrolled from May 2007每May 2008, regardless of signs or symptoms of active TB. Prior TB history and current TB treatment status were self-reported. Subjects expectorated sputum for culture (MGIT liquid and 7H11 solid medium). Positive cultures were tested for susceptibility to first- and second-line anti-tuberculous drugs. The prevalence of drug-resistant TB, stratified by prior TB history and current TB treatment status, was assessed. Results 1,035 subjects had complete culture results. Median CD4 count was 92/米l (IQR 42每150/米l). 267 subjects (26%) reported a prior history of TB and 210 (20%) were receiving TB treatment at enrollment; 191 (18%) subjects had positive sputum cultures, among whom the estimated prevalence of resistance to any antituberculous drug was 7.4% (95% CI 4.0每12.4). Among those with prior TB, the prevalence of resistance was 15.4% (95% CI 5.9每30.5) compared to 5.2% (95% CI 2.1每8.9) among those with no prior TB. 5.1% (95% CI 2.4每9.5) had rifampin or rifampin plus INH resistance. Conclusions The prevalence of TB resistance to at least one drug was 7.4% among adults with positive TB cultures initiating ART in Durban, South Africa, with 5.1% having rifampin or rifampin plus INH resistance. Improved tools for diagnosing TB and drug resistance are urgently needed in areas of high HIV/TB prevalence.
%U http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0043281