992. Drug-Resistant Tuberculosis Among HIV-infected Patients Starting Antiretroviral Therapy in Durban, South Africa
Session: Poster Abstract Session: Clinical Studies of Tuberculosis
Saturday, October 22, 2011
Room: Poster Hall B1

Background: Drug-resistant tuberculosis (TB) is a global threat, particularly in sub-Saharan Africa. Our objective was to estimate the prevalence of drug-resistant TB and describe the resistance patterns observed in patients commencing ART in an urban clinic in Durban, South Africa.

Methods: From May 2007-May 2008, consecutive HIV-infected adults (>18y/o) commencing ART literacy were enrolled prospectively, regardless of signs or symptoms of active TB. A prior history of TB and current TB treatment status were obtained by self-report. Patients expectorated sputum spontaneously or with nebulization for culture (MGIT liquid and 7H11 solid medium). Positive solid or MGIT cultures containing acid fast bacilli were subcultured on quadrant 7H10 agar for susceptibility to isoniazid (INH), rifampin, streptomycin, ethambutol, ofloxacin, and kanamycin using the 1% proportional method. We estimated the prevalence of drug-resistant TB, stratified by prior TB history and current TB treatment status.

Results: During the study, 1,035 HIV-infected patients had complete culture results. Median CD4 count was 92/Ál (IQR 42-150/Ál). Two-hundred sixty-seven patients (26%) reported a prior history of TB and 210 patients (20%) were receiving TB treatment at study enrollment. Of 191 (19%) patients with positive cultures, 175 had sensitivity data available. The estimated prevalence of resistance to any antituberculous drug was 7.4% (95% CI 4.0-12.4). Among those with prior history of TB treatment, the estimated prevalence of resistance was 15.4 % (95% CI 5.9-30.5) compared to 5.2% (95% CI 2.1-8.9) among those with no prior history of TB (Figure). 5.1% (95% CI 2.5-9.5) are estimated to have rifampin or rifampin plus INH resistance (multi-drug resistant TB).

Conclusion: The estimated prevalence of TB resistant to at least one drug is 7.4% (95% CI 4.0-12.4) among adults initiating HIV care in Durban, South Africa, with 5.1% (95% CI 2.5-9.5) having rifampin or rifampin plus INH resistance. Many patients with resistant TB reported no prior TB treatment, suggesting primary infection with drug-resistant strains. Improved infection control measures, as well as more rapid tools for diagnosing TB and drug resistance, are urgently needed in areas of high HIV/TB prevalence.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Jeffrey K. Hom1, Bingxia Wang, PhD2, Senica Chetty, MSc3, Janet Giddy, MBChB, MFamMed3, Matilda Mazibuko3, Jenny Allen, B. Tech4, Rochelle Walensky, MD, MPH, FIDSA2, Elena Losina, PhD5, Kenneth A. Freedberg, MD, MSc2 and Ingrid V. Bassett, MD, MPH2, (1)Harvard Med. Sch., Boston, MA, (2)MA Gen. Hosp., Boston, MA, (3)McCord Hosp., Durban, South Africa, (4)Univ. of Kwazulu-Natal Microbiol. Laboratory and the Med. Res. Council, Durban, South Africa, (5)Brigham and Women's Hosp., Boston, MA

Disclosures:

J. K. Hom, None

B. Wang, None

S. Chetty, None

J. Giddy, None

M. Mazibuko, None

J. Allen, None

R. Walensky, None

E. Losina, None

K. A. Freedberg, None

I. V. Bassett, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.