TITLE:
Clinical Correlates and Drug Resistance in HIV-Infected and -Uninfected Pulmonary Tuberculosis Patients in South India
AUTHORS:
Sara Chandy, Elsa Heylen, Baijayanti Mishra, Maria Lennartsdotter Ekstrand
KEYWORDS:
Pulmonary TB, HIV, Anti-Tubercular Drug Resistance
JOURNAL NAME:
World Journal of AIDS,
Vol.6 No.3,
September
9,
2016
ABSTRACT: Objectives: To examine demographics,
clinical correlates, sputum AFB (acid fast bacilli) smear grading DOTS
(Directly Observed Therapy Short Course) uptake, and drug resistance in a
cohort of newly-diagnosed, smear positive pulmonary tuberculosis (TB) patients
with respect to HIV status at baseline, and compare smear conversion rates,
side effects and mortality after two months. Design: A prospective study among
54 HIV positive and 41 HIV negative pulmonary TB patients. Data were collected
via face-to-face interviews, review of medical records, and lab tests. Results:
HIVTB co-infected patients, though more symptomatic at baseline, showed more
improvement in their symptoms compared to HIV-uninfected TB patients at follow-up.
The HIV co-infected group had more prevalent perceived side effects, and sputum
smear positivity was marginally higher compared to the HIV negative group at
follow-up. Mortality was higher among the HIV-infected group. Both groups had
high rates of resistance to first-line anti-tubercular drugs, particularly
isoniazid. There was no significant difference in the drug resistance patterns
between the groups. Conclusions: Prompt initiation and provision of daily
regimens of ATT (Anti-Tubercular treatment) along with ART (Anti-Retroviral
treatment) via ART centers is urgently needed in India. As resistance to ART
and/or ATT is directly linked to medication non-adherence, the use of
counseling, regular reinforcement, early detection and appropriate intervention
strategies to tackle this complex issue could help prevent premature mortality
and development of resistance in HIV-TB co-infected patients. The high rate of
isoniazid resistance might preclude its use in India as prophylaxis for latent
TB in HIV infected persons as per the World Health Organization (WHO)
guideline.