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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Detection of a substantial rate of multidrug-resistant tuberculosis in an HIV-infected population in South Africa by active monitoring of sputum samples
Clinical Infectious Diseases, Volume 50, No. 7, Year 2010
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Description
Background. Tuberculosis (TB) coinfection with human immunodeficiency virus (HIV) is a substantial problem in South Africa. There has been a presumption that drug-resistant strains of TB are common in South Africa, but few studies have documented this impression. Methods. In Phidisa, a joint observational and randomized HIV treatment study for South African National Defence Force members and dependents, an initiative was launched to test subjects (by use of microbiologic TB test) who appeared to be at high risk. We report results for HIV-infected subjects. Results. TB was identified by culture in 116 (19.9%) of 584 patients selected for sputum examination on the basis of suggestive symptoms. Smear was an insensitive technique for confirming the diagnosis: only 33% of culture-positive patients were identified by smear, with a 0.2% false-positive rate. Of the 107 culture-positive individuals with susceptibility testing, 22 (20.6%) were identified to be multidrug resistant (MDR), and 4 (3.7%) were identified to be extensively drug resistant. Culture-positive cases with a history of TB treatment had more than twice the rate of MDR than those without (27.1% vs 11.9%; P = .05). Conclusions. TB is common in this cohort of HIV-infected patients. Smear was not a sensitive technique for identifying culture-positive cases in this health system. Drug susceptibility testing is essential to proper patient management because MDR was present in 20.6% of culture-positive patients. Better management strategies are needed to reduce the development of MDR TB, because so many of these patients had received prior antituberculous therapy that was presumably not curative. © 2010 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Hassim, Shaheen
South Africa, Pretoria
South African National Defence Force
Shaw, Pamela A.
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Sangweni, Phumele
South Africa, Pretoria
South African National Defence Force
Malan, Lizette
South Africa, Pretoria
South African National Defence Force
Ntshani, Ella
South Africa, Pretoria
South African National Defence Force
Mathibedi, Monkwe J.
South Africa, Pretoria
South African National Defence Force
Stubbs, Nomso
South Africa, Pretoria
South African National Defence Force
Metcalf, Julia A.
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Eckes, Risa
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Masur, Henry
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Komati, Stephanus
South Africa, Pretoria
South African National Defence Force
Statistics
Citations: 27
Authors: 11
Affiliations: 2
Identifiers
Doi:
10.1086/651119
ISSN:
10584838
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
South Africa