Converging risk factors but no association between HIV infection and multidrug-resistant tuberculosis in Kazakhstan
METHODS: We describe the epidemiology of multidrug resistance and HIV among TB patients, using the 2007–2011 national electronic TB register.
RESULTS: HIV test results were available for 97.2% of TB patients. HIV prevalence among TB patients increased from 0.6% in 2007 to 1.5% in 2011. Overall, 41.6% of patients had a positive smear at diagnosis, 38.6% a positive culture and 51.7% either a positive smear or culture. Drug susceptibility testing (DST) results were available for 92.7% of culture-positive cases. Socio-economic factors independently associated with both HIV and MDR-TB were urban residency, drug use, homelessness and a history of incarceration. In adjusted analysis, HIV positivity was not associated with MDR-TB (OR 1.0, 95%CI 0.86–1.2). Overall, among TB patients with DST and HIV test results available, 65.0% were positive for neither HIV nor MDR-TB, 33.5% only for MDR-TB, 0.9% only for HIV and 0.6% for both HIV and MDR-TB. Among injection drug users, 12.5% were positive for HIV and MDR-TB.
CONCLUSION: We showed increasing HIV prevalence among TB patients in Kazakhstan. HIV was not an independent risk factor for MDR-TB, but risk factors were largely overlapping and we did identify subgroups at particular risk of HIV-MDR-TB co-infection, notably drug users. Enhanced efforts are necessary to provide care to these socially vulnerable populations.
Document Type: Research Article
Affiliations: 1: KNCV Tuberculosis Foundation, The Hague, The Netherlands; and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands 2: National Center for Tuberculosis Problems, Almaty, Kazakhstan; and KNCV Tuberculosis Foundation, Almaty, Kazakhstan 3: National Center for Tuberculosis Problems, Almaty, Kazakhstan 4: KNCV Tuberculosis Foundation, Almaty, Kazakhstan 5: Tuberculosis Grant Project Implementation Unit, Global Fund Against AIDS, Tuberculosis and Malaria, Almaty, Kazakhstan
Publication date: 01 April 2013
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