HIV and multidrug-resistant tuberculosis: overlapping epidemics

To the Editor: People infected with Mycobacterium tuberculosis and HIV are much more likely to develop active tuberculosis (TB) than people with M. tuberculosis but without HIV [1]. Patients infected with multidrug-resistant (MDR)-TB (defined as resistance to at least rifampicin and isoniazid, the two most powerful anti-TB drugs) require longer, more expensive treatment regimens than drug-susceptible TB, with poorer treatment success [2], [3]. Therefore, MDR-TB poses a major challenge to the control of TB, with an estimated global disease incidence in 2012 of ∼450 000 cases (95% CI 300 000–600 000) [4]. Although HIV is a powerful risk factor for all forms of TB and institutional outbreaks of MDR-TB among people living with HIV have been reported [5], population-level data on the association between HIV infection and MDR-TB are limited. We explored the relationship between HIV infection and MDR-TB disease using data reported by member states to the World Health Organization (WHO) within the context of the Global Project on Anti-TB Drug Resistance Surveillance. The data were aggregated numbers of cases reported from either drug resistance surveys or continuous surveillance systems. Such surveys are epidemiological studies designed to measure drug resistance among a representative sample of notified pulmonary TB patients. Continuous surveillance is based on routine drug susceptibility testing of all bacteriologically confirmed TB patients. Subnational level data that were not representative of the entire country were excluded from the analysis, except for the Russian Federation and Ukraine, which are high …