1 in 4 HIV-TB patients is resistant to drugs

MUMBAI: Several HIV-positive people in the city directly contract drug-resistant tuberculosis as their first TB infection, shows a new study by international NGO Medecins Sans Frontieres (MSF) in Mumbai. The study, conducted by the BMC along with MSF and published in medical journal PLoS One, last week, reveals that the proportion of drug-resistant TB was 25% among new cases of TB and 44% among previously treated TB cases.

"The study provides evidence that primary transmission is the cause of DR-TB (drug-resistant) in as many as one in four newly-diagnosed TB patients," said the MSF release. These patients were exposed to DR-TB mycobacterium either in their communities or during their visits to health facilities as they have no previous records of receiving treatment for TB.

The study's co-author Dr Arun Bamne, who was the city's executive health officer until recently, said such studies give insight into the TB load among marginalised populations and help shape specific health intervention programmes.

The study was conducted among HIV-positive people attending seven ART (anti-retroviral therapy) centres. More than 14,000 visits were studied, and sputum of 1,724 patients with TB symptoms was collected.

The study was released to coincide with the Union World Conference on Lung Health which begins in Barcelona later this week. "The findings reinforce the need for national health authorities to ensure timely diagnosis of DR-TB (drug resistant), especially for vulnerable populations and including people living with HIV, in order to curb primary transmission," said the MSF press release.

"We need to urgently prevent transmission of DR-TB to others. With DR-TB, treatment is prevention, and these findings should lead to a stronger focus on diagnostics and treatment of DR-TB, particularly in high HIV-prevalent settings," said Eldred Tellis of the Mumbai AIDS Forum.

The study says there is a need to promptly diagnose drug-resistance among all HIV-infected people by systematically offering access to first- and second-line drug-sensitivity testing to patients with 'presumptive TB' rather than 'presumptive DR-TB' and tailor treatment regimen based on the resistance patterns. MSF has been running an HIV/DR-TB clinic in Mumbai since 2006, focusing on patients with drug-resistant TB, HIV or both infections together.

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