Multidrug-resistant TB and HIV in Thailand: overlapping, but not independently associated, risk factors.
Somsak AkksilpWanpen WattanaamornkiatWanitchaya KittikraisakSriprapa NateniyomSomsak RienthongChawin SirinakKeerataya NgamlertWiroj MankatitthamWanchai SattayawuthipongSurin SumnapunNorio YamadaPatama MonkongdeeAmornrat AnuwatnonthakateChannawong BurapatCharles D. WellsJordan W. TapperoJay K. Varma
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The HIV and multi-drug resistant tuberculosis (MDR-TB) epidemics are closely linked. In Thailand as part of a sentinel surveillance system, we collected data prospectively about pulmonary TB cases treated in public clinics. A subset of HIV-infected TB patients identified through this system had additional data collected for a research study. We conducted multivariate analysis to identify factors associated with MDR-TB. Of 10,428 TB patients, 2,376 (23%) were HIV-infected; 145 (1%) had MDR-TB. Of the MDR-TB cases, 52 (37%) were HIV-infected. Independent risk factors for MDR-TB included age 18-29 years old, male sex, and previous TB treatment, but not HIV infection. Among new patients, having an injection drug use history was a risk factor for MDR-TB. Of 539 HIV-infected TB patients in the research study, MDR-TB was diagnosed in 19 (4%); the only significant risk factors were previous TB treatment and previous hepatitis. In Thailand, HIV is common among MDR-TB patients, but is not an independent risk factor for MDR-TB. Populations at high risk for HIV-young adults, men, injection drug users - should be prioritized for drug susceptibility testing.Cite
Objective To compare the characteristices and anti-TB treatment outcome of HIV-positive TB patients from TB programme and AIDS programme.Methods We collected the TB-related information from TB information management system and HIV-related information from HIV institutions.In the selected fouteen counties within six provinces,a total of 925 TB/HIV cases were registered between Spe.2007 and Aug.2009,673(72.8%) were known to be HIV positive and referred by HIV institutions and 252(27.2%) were newly detected HIV positive cased by TB institutions.Results In areas where HIV transmited mainly through illegal blood donation,the treatment success rate was 90.6%(328/362)and 82.4%(70/85)(χ2=4.806,P=0.034)and the death rate was 7.5%(27/362)and 16.5%(14/85)(χ2=6.711,P=0.010)repsectively for TB/HIV patients from HIV institutions and TB institutions.In areas where HIV transmited mainly through drug use and sex,the treatment success rate was 60.1%(187/311)and 68.9%(115/167)(χ2=3.563,P=0.059)and the incidence of adverse drug response was 24.1%(75/311) and 13.8%(23/167)(χ2=7.132,P=0.009)repsectively for TB/HIV patients from HIV institutions and TB institutions.Conclusion We should intensify TB case finding in people living with HIV/AIDS.Meanwhile,HIV testing in TB patient is also an important measure.
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The disease condition of the patient at the time of diagnosis of tuberculosis (TB) greatly influences subsequent TB treatment and prognosis. Here we report on the data of HIV infection, diabetes and drug susceptibility test results, which were added to the central TB surveillance database from 2007. In the TB surveillance system, the item 'HIV' was classified into three codes, 'has HIV', 'does not have HIV' and 'unknown'. Although it was requested that 'has HIV' and 'does not have HIV' be coded based on HIV test results, this rule was not strictly followed in public health centers, and medical institutions usually give information to a public health center only in the case of HIV positive. Therefore, 'does not have HIV' cannot be assumed based on the test result. Hence, we show only the number of TB patients having HIV infection. In 2007-2008, 124 TB patients newly notified were reported as having HIV. Of those, 110 (88.7%) were male and 14 (11.3 %) were female, and 25 (20.2%) were foreigners. Although the ages of those having HIV were broadly distributed from the 20's to 70's, most patients were from 30 to 44 years old. As to diabetes, 12.9% (3,192/24,760) of newly notified TB patients in 2008 were reported as having diabetes, and this proportion was higher among males (15.0%) than females (9.2%). Susceptibility test results of 8,505 culture positive pulmonary TB patients were obtained through the system in 2007-2008, among which 98 (1.2%) were MDR TB. The proportion of MDR was different between new treatment and retreatment cases, 0.6% of new treatment and 6.5% of retreatment, respectively. The proportion of MDR was the highest among 20's in both males and females. More than half of MDR TB patients in 20's were foreigners.
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Introduction. A nationwide survey to investigate risk factors for multidrug-resistant tuberculosis (MDR-TB) was conducted in Belarus in 2010-2011. A total of 1,344 TB patients were enrolled.
Results. MDR-TB was found in 32.3% (95% CI: 29.7-35.0) and 75.6% (95% CI: 72.1-78.9) of new and previously treated patients, respectively. History of previous treatment for TB was the strongest independent risk factor for MDR-TB (Odds Ratios [OR] 6.1, 95%CI: 4.8-7.71) followed by HIV infection (OR 2.2, 95%CI: 1.4-3.5). Other independent risk factors were young age (<35 years) (OR 1.4, 95%CI: 1.0-1.8), history of imprisonment (OR 1.5, 95%CI: 1.1-2.0), disability in such a way as to be unable to work (OR 1.9, 95%CI: 1.2-3.0), alcohol abuse (OR 1.3, 95%CI: 1.0-1.8), and smoking (OR 1.5, 95%CI: 1.1-2.0).
Discussion. MDR-TB is a widespread problem in Belarus, with very high levels documented countrywide. The convergence of the MDR-TB and HIV epidemics and association between MDR-TB and numerous risk factors calls for stronger collaboration between TB and HIV control programmes and a more targeted approach to high-risk groups. Adherence to TB treatment could be improved by integrating treatment for alcohol use disorders into TB services and enhancing patient incentives and enablers.
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[Objective]To investigate the prevalence of TB in AIDS patients and HIV infection among TB patients and the influencing factors.[Methods]260 AIDS and 580 TB patients were investigated with the questionnaire about the detection rates of double infection and the influencing factors.Also their medical records were checked.[Results]The prevalence of TB was 35% in 260 AIDS patients(pulmonary tuberculosis 29.2%,extrapulmonary tuberculosis 5.8%),HIV infection rate was 2.8% in 580 TB patients.Low income was the primary factor resulting in AIDS patients taking TB;drug using and commercial sexual behavior played important roles among TB patients infecting HIV.[Conclusion]The prevalence TB in AIDS patients is high,lower income group is easily infected TB;the rate of HIV infection in TB patients is higher than that of common people.The main reasons of TB patients infected HIV are drug using and commercial sex behaviors.
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Tuberculosis is one of the world's most common causes of death in the era of Human immunodeficiency virus. The purpose of this study was to determine the prevalence and associated factors of TB/HIV co-infection.Hospital based retrospective studies were conducted among adult HIV-positive patients. Logistic regression method and Chi square test were applied.A total of 571 HIV positive study participants were enrolled. Of these, 158 (27.7%) were found to have pulmonary tuberculosis. Lower baseline CD4 count<200cell/µl, patients who drunk alcohol, patients who were ambulatory at the initiation of ART, patients whose marital status was single were significant predictors for increased risk of tuberculosis in PLWHIV (P <0.05). Non smoker patients, patients in WHO clinical stage I, patients in WHO clinical stage II and ownership of the house had significant protective benefit against risk of TB (P <0.05).The prevalence of TB/HIV co-infection in adults on ART in our study was moderately high. Having advanced clinical status and presence of risk factors were found to be the predicting factors for co-infection. The health office should open TB/HIV co-infection units in the hospitals and health workers should be cautious when a patient has an advanced disease.
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The aim of this study is to assess the prevalence and associated factors ofnon-uptake of human immunodeficiency virus (HIV) testing by tuberculosis hospital patients in Thailand. In 2014, a cross-sectional survey was conducted amongst 425 TB patients across 42 hospitals, two province, in all four regions in Thailand. All new TB and new retreatment patients were consecutively interviewed within one month of anti-tuberculosis treatment. The outcome was self-reported HIV testing after TB diagnosis, validated using clinic registers. Results indicate that 38.4% of the 425 participants had not undergone HIV testing. Multivariate analysis found 61 years and older and being a migrant worker was significantly associated with associated with “Not tested for HIV”, while other socio-demographic factors, geolocality, TB diagnosis characteristics, TB treatment status, TB knowledge substance use and TB-AIDS stigma were not significantly associated with associated with “Not tested for HIV”. In conclusion, the level of HIV testing among TB hospital patients was suboptimal, and the Ministry of Public Health should continue to scale-up HIV testing and other collaborative TB-HIV services at health facilities.
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Backgroud: The burden of TB and HIV infection is estimated to be about 512/100,000 and 3,000,000 people respectively. However, accurate data on TB/HIV co-morbidity in different parts of Nigeria were not available due to limited access to HIV Counseling and Testing (HCT) by individuals with TB infection. This study was designed to determine the true rate of HIV infection among newly diagnosed TB patients by providing comprehensive HCT services in 43 DOTS centers in Oyo State, Southwestern Nigeria. Methods: All patients meeting the case definition for TB suspects who presented at each of the 43 DOTS Centres were counselled and those who consented tested for presence of HIV antibodies using HIV 1/2 Determine, Unigold and Stat-Pak rapid test kits in a serial algorithm. Results: A total of 13,109 TB positive patients were enrolled for the study, out of which 1605 (12.3%) tested positive for HIV antibodies. HIV infection was higher among female (15.5%) than male (9.5%) TB patients (p 0.05). The rates also varied among the age groups, ranging from 4.3% in the 10 - 19 years to 18.0% in the 40 - 49 years age group. A relatively high rate (10.5%) of HIV infection was found among children less than ten years of age. Conclusion: The results of this work show the true burden of TB/HIV in any region in Nigeria for the first time. Higher rate of TB/HIV co-infection among female patients and children are significant and important factors that should be considered in the planning of intervention measures in Nigeria and other TB and HIV endemic countries in Africa.
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Tuberculosis (TB) screening among patients infected with Human Immunodeficiency Virus (HIV) is one of the approaches for controlling TB-HIV co-infection. The absence of typical TB symptoms among HIV-infected patients makes diagnosis challenging. Identifying predisposing risk factors of TB among HIV-infected patients could possibly guide TB diagnosis and treatment. This study was designed to identify some important factors associated with TB among HIV-infected patients and to quantify the strength of this association.In 2010, a case control study was conducted in Khartoum State, Sudan. Cases and controls were selected by simple random sampling with a 1:2 ratio; 97 cases and 194 controls were enrolled in the study. A logistic regression model was built to estimate and quantify the strength of the association between the study variables and the outcome; a p-value less than 0.05 was considered the cut-off point for a significant statistical association.Past history of TB, CD4 count < 200 cells/µl, late clinical stages, non-employment, and no formal education were found to be risk factors for developing TB among HIV-infected patients. The adjusted ORs and 95% CIs were (6.9: 3.75-12.99), (4.8: 1.57-15.26), (5.8: 1.88-17.96), (2.5: 1.26-5.03), and (2.5: 1.28-4.63), respectively. Poor adherence, marital status, age, and gender are not associated with developing TB among HIV patients.HIV patients who have at least one of the risk factors found in this analysis are at higher risk of TB; therefore, they should be screened more frequently and treated promptly, especially HIV patients with previous TB.
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