Drug-resistant Tuberculosis and HIV Co-infection
HIV/
AIDS pandemic has caused a resurgence of TB, resulting in increased morbidity and mortality worldwide.
HIV
and Mycobacterium tuberculosis
have a synergistic interaction; each accentuates progression of the other. MDR-
TB has been a particular concern among HIV-infected persons. MDR-
TB substantially reduce survival among patients co-infected with HIV and TB.Some of the factors that have contributed to the number of cases of MDR-
TB, both in general and among HIV-infected individuals are:
- Delayed diagnosis (
HIV co-infected TB patients are more often smear negative) and delayed determination of drug susceptibility (prevailing methods take several weeks to complete)
- Susceptibility of immunosuppressed individuals for not only acquiring MDR-
TB but for rapid disease progression, which may result in rapid transmission of the disease to other immunosuppressed patients
- Inadequate respiratory isolation procedures and other environmental safety conditions, especially in confined areas such as prisons
- Noncompliance or intermittent compliance with anti-tuberculosis drug therapy
A study of drug resistance tuberculosis and HIV status was undertaken in patients with smear positive and smear negative tuberculosis in order to define their levels in new smear positive patients. Sputum from 525 patients were cultured, of which 385 (73%) were smear positive and 140 (27%) were smear negative. Multi Drug Resistant tuberculosis was found in 14% of patients with tuberculosis. HIV was found in 1% of TB patients with sensitive cultures and 6.3% of MDR-
TB patients. The level of MDR-
TB in HIV positive
was twice as high as in negative patients.
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Conclusion
Drug resistant tuberculosis has been reported since the early days of introduction of anti-tubercular chemotherapy, but multi-drug resistant tuberculosis, has emerged as an area of growing concern, and is posing threat to global efforts of tuberculosis control.
Worldwide emergence of multidrug resistant Mycobacterium tuberculosis has been reported in both developed and developing countries. While host genetic factors may contribute to the development of MDR-TB, incomplete and inadequate treatment is the most important factor leading to its development, suggesting that it is often a man made tragedy.
New research in the areas involving molecular biology and application of these in the field of epidemiology could help in better understanding of the mechanisms of drug resistance, development of newer diagnostic tools and effective drugs to control multidrug resistant tuberculosis.
Health-care providers: Inadequate regimens
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Patients:
Inadequate drug intake
Drugs:
Inadequate supply/quality
Inadequate drug intake
Drugs:
Inadequate supply/quality
- Inappropriate guidelines
- Noncompliance with guidelines
- Absence of guidelines
- Poor training
- No monitoring of treatment
- Poorly organized or funded TB control programmes Poor quality of drugs
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Unavailability of certain drugs
(stock-outs or delivery disruptions) Poor storage conditions I Wrong dose or combination
Poor adherence (or poor DOT) Lack of information Lack of money (no treatment available free of charge) Lack of transportation
Advers
e effects i Social barriers
Malabsorption
Substance dependency disorders