Use of Genotype MTBDR Plus (HAIN Lifesciences) assay for the Diagnosis of Drug Resistant Tuberculosis in HIV and Tuberculosis co - infected Patients

Title: Use of Genotype MTBDR Plus (HAIN Lifesciences) assay for the Diagnosis of Drug Resistant Tuberculosis in HIV and Tuberculosis co - infected Patients.

Background: The use of drug resistance assays to test for drug resistant tuberculosis in HIV and tuberculosis (TB) co-infection is rarely done in resource poor settings like India. We undertook this study to understand the prevalence and efficacy of this method in a tertiary care hospital in western India.

Methods: HIV infected patients during the period of 2014 to 2016 were subjected to a WHO tuberculosis symptom score 3 monthly. Those patients with a positive result were exposed to a battery of investigations like basic blood biochemistry, imaging, biopsy and HAIN test. In all these patients baseline demographic data like age, sex, baseline CD4 count and hepatitis B status were recorded. The samples collected were sputum, pleural fluid, lymph node and intestinal biopsies.

Results: We investigated 37 patients (23.3% females) with HIV and TB from 2014 to 2016. Median age of cohort was 40 and the median baseline CD4 count was 90 cells/mm³. 16 patients (43.24%) had Baseline tuberculosis of which 62.5% was extra pulmonary TB. 11 of these patients had a baseline HAIN test done which revealed 4 patients (25%) with incident drug resistant TB. In 30 patients with Incident TB (81%), 20 patients (66.67%) had pulmonary TB while the rest had pulmonary TB. 7 patients (23.3%) in the incident TB group were found to have multidrug resistant tuberculosis (see image 1).

Conclusion: Drug resistant assays like HAIN test is a good tool for detecting multidrug resistant pulmonary and extra pulmonary TB. In HIV and TB co infections in a resource limited country like India, it can serve as an excellent tool to guide therapy in tuberculosis.

Image 1: HAIN test for diagnosis of drug resistant TB