Free Content Converging risk factors but no association between HIV infection and multidrug-resistant tuberculosis in Kazakhstan

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SETTING: Kazakhstan is a country with a low HIV/AIDS (human immunodeficiency virus/acquired immune-deficiency syndrome) burden, but a high prevalence of multidrug-resistant tuberculosis (MDR-TB).

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.

Keywords: HIV; Kazakhstan; MDR-TB; drug resistance; tuberculosis

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: April 1, 2013

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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