Determinants of drug-resistant tuberculosis: analysis of 11 countries
Abstract:SETTING: Eleven countries/territories.
OBJECTIVES: Global information on the determinants of drug-resistant tuberculosis (TB) based on representative data is not available. We therefore studied the relationship between demographic characteristics, prior TB treatment, and human immunodeficiency virus (HIV) infection with anti-tuberculosis drug resistance.
METHODS: Population-based representative data on new and previously treated patients with TB collected within an international drug resistance surveillance network.
RESULTS: Of 9615 patients, 8222 (85.5%) were new cases of TB and 1393 (14.5%) were previously treated cases. Compared with new cases, previously treated cases were significantly more likely to have resistance to one (OR = 2.5, 95%CI 2.1–3.0; P < 0.001), two (OR = 4.6, 95%CI 3.7–5.6; P < 0.001), three (OR = 11.5, 95%CI 8.6–15.3; P < 0.001), and four (OR = 18.5, 95%CI 12.0–28.5; P < 0.001) drugs. An approximately linear increase in the likelihood of having multidrug-resistant tuberculosis (MDR-TB) was observed as the total time (measured in months) of prior anti-tuberculosis treatment increased (P < 0.001, κ2for trend). In multivariate analysis, prior TB treatment for 6–11 months (OR = 7.6, 95%CI 2.6, 22.4; P < 0.001) and ≥12 months (OR 13.7, 95%CI 4.5–41.6; P < 0.001), but not HIV positivity, was associated with MDR-TB.
CONCLUSION: This study shows that prior but ineffective treatment is a strong predictor of drug resistance, and that HIV is not an independent risk factor for MDR-TB. The association between length of treatment and drug resistance may reflect longer treatment as a result of treatment failure in patients with drug resistance; it may also reflect irregular prior treatment for TB, leading to drug resistance.
Document Type: Regular Paper
Affiliations: 1: World Health Organization, Communicable Diseases, Geneva, Switzerland 2: Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, Georgia, United States 3: National Laboratory of Tuberculosis, La Paz, Bolivia 4: Provincial Centre for TB Control, Shandong, PeopleÕs Republic of China 5: Korean Institute of Tuberculosis, Seoul, Republic of Korea 6: National TB Control Programme, Ministry of Health, Maseru, Lesotho 7: National Tuberculosis Centre, Kathmandu, Nepal 8: National Tuberculosis Control Programme, Lima, Peru 9: Ministry of Health, Lisbon, Portugal 10: National Reference Laboratory, National Leprosy/TB Control Programme, Freetown, Sierra Leone 11: Microbiology and Parasitology Service, Vall dÕHebron Hospitals, Barcelona, Spain 12: National TB Control Programme, Ministry of Health, Manzini, Swaziland 13: Medical Research Council, National Tuberculosis Research Programme, South Africa
Publication date: October 1, 2001
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