Drug-resistant TB now epidemic among HIV+ people in Mumbai

Transmission from one person to another, not inadequate treatment, is major cause for spread of disease, says study investigator

By Kundan Pandey
Published: Monday 27 October 2014

imageA recent study has revealed that many HIV-positive patients in Mumbai have now developed drug-resistant tuberculosis (DR-TB).  The study was conducted by international non-profit Médecins Sans Frontières (MSF) that works to make medicines accessible to the needy.

Published in PLoS One, the study has hinted at an alarmingly high burden of drug-resistant tuberculosis (DR-TB) among HIV-positive patients at antiretroviral therapy (ART) centres in Mumbai.

The study looked at the DR-TB burden amongst attendees of antiretroviral therapy (ART) centres in high HIV-burden settings in Mumbai. During the research that was conducted in collaboration with the national health authorities in Mumbai, between February 2013 and January 2014, attendees at seven large-scale ART centres were screened during more than 14,000 visits. The sputum of 1,724 patients with TB symptoms was collected.

The examination revealed that the rate of DR-TB is 25 per cent among new cases of TB and 44 per cent among previously treated TB cases.

The study raises concerns as it provides evidence that primary transmission (from one person to the other) is the cause of DR-TB in as many as one in four newly-diagnosed TB patients. 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 the disease.

Stringent measures a must to control epidemic
The data highlights the urgent need to address DR-TB among people living with HIV by systematically offering screening, drug susceptibility testing (DST) and access to treatment based on actual resistance patterns.

MSF principal investigator Petros Isaakidis says, “In hot spots such as the slums of Mumbai, and among vulnerable groups such as people living with HIV, DR-TB epidemic may be driven by primary transmission, rather than simply by lack of adherence to TB treatment.”

He suggests that the government must pay more attention to primary transmission of DR-TB, particularly in settings of high HIV prevalence and rapid TB spread. Promptly diagnosing and treating DR-TB is the solution to curb primary transmission, he adds.

“This study comes at the right time. Studies like this are complementary to the national survey and are essential to get a close-up picture of the DR-TB epidemic in hot spots and marginalised populations,” says Arun Bamne, co-author of the study and former executive health officer of Mumbai’s Public Health Department.

Poor outcomes in a cohort of HIV-infected adolescents undergoing treatment for multidrug-resistant tuberculosis in Mumbai, India

Global tuberculosis report 2014

Incidence of multidrug-resistant tuberculosis disease in children: systematic review and global estimates

Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis

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