The association between HIV and anti-tuberculosis drug resistance in England and Wales

¹ Tuberculosis Section, Respiratory Diseases Dept, Health Protection Agency Centre for Infections, London, United Kingdom
² Infectious Diseases Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
³ University of East Anglia, Norwich, United Kingdom
⁴ HIV and AIDS Reporting Section, HIV and STI Dept, Health Protection Agency Centre for Infections, London, United Kingdom

^* To whom correspondence should be addressed. E-mail: clare.french{at}hpa.org.uk.

	Abstract

In the UK, HIV is considered to be a risk factor for anti-tuberculosis drug resistance. Evidence on the association is, however, inconclusive and there is little population level data. This study investigated the association in England and Wales during 1999-2005.

National tuberculosis surveillance data for adults were matched to HIV/AIDS reports. Unmatched cases were assumed to be HIV-negative. Separate analyses were conducted on new tuberculosis cases and those with a previous diagnosis. Logistic regression was used for univariable and multivariable analyses.

There were 1657 previously diagnosed cases (80 HIV-positive) and 18, 130 new cases (1156 HIV-positive). Isoniazid resistance was found in 8.1% of previously diagnosed cases and 6.6% of new cases, and multidrug resistance (MDR) in 2.8% and 0.7% respectively. There was no evidence of an association between HIV and anti-tuberculosis drug resistance among previously diagnosed cases. Among new cases, there was no overall association between HIV and isoniazid resistance or MDR after adjusting for confounding factors. White HIV-positive patients were more likely to have MDR, but numbers were small.

In contrast to some previous studies, this large up-to-date study provides little evidence that HIV co-infected tuberculosis patients in England and Wales are at increased risk of first-line anti-tuberculosis drug resistance.