Skip to main content

Main menu

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • ERS Guidelines
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • Peer reviewer login
    • WoS Reviewer Recognition Service
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • ERS Guidelines
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • Peer reviewer login
    • WoS Reviewer Recognition Service
  • Alerts
  • Subscriptions

HIV and multidrug-resistant tuberculosis: overlapping risk factors

Susan van den Hof, Aigul Tursynbayeva, Tleukhan Abildaev, Malik Adenov, Svetlana Pak, Shakhimurat Ismailov
European Respiratory Journal 2015 45: 567-569; DOI: 10.1183/09031936.00131014
Susan van den Hof
1KNCV Tuberculosis Foundation, The Hague, The Netherlands
2Academic Medical Center and Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: susan.vandenhof@kncvtbc.org
Aigul Tursynbayeva
3KNCV Tuberculosis Foundation, Representative Office for Central Asia, Almaty, Kazakhstan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Tleukhan Abildaev
4National Center of Tuberculosis Problem, Almaty, Kazakhstan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Malik Adenov
4National Center of Tuberculosis Problem, Almaty, Kazakhstan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Svetlana Pak
3KNCV Tuberculosis Foundation, Representative Office for Central Asia, Almaty, Kazakhstan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Shakhimurat Ismailov
5Global Fund against AIDS, Tuberculosis and Malaria – Tuberculosis Grant Project Implementation Unit, Almaty, Kazakhstan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

Overlapping risk factors may explain observed association between HIV and drug resistance in TB patients http://ow.ly/DdRGT

To the Editor:

Recent meta-analyses have indicated that, on average, new HIV-positive tuberculosis (TB) patients are at increased risk of multidrug-resistant (MDR)-TB compared with HIV-negative patients, while this risk is less clear for previously treated TB patients [1, 2]. In a recent issue of the European Respiratory Journal, Dean et al. [3] reported an association between HIV infection and MDR-TB disease based on aggregated data reported annually to the World Health Organization. Out of 24 countries where ⩾75% of TB patients had a HIV test result and at least one HIV-positive MDR-TB case was reported, 11 showed a significant positive association between HIV and multidrug resistance among TB patients, mostly in countries with a high prevalence of multidrug resistance. One of these countries was Kazakhstan, which added data for 40 975 out of the 104 781 patients included in their report.

The authors pointed out that there are likely to be risk factors common to HIV-positive and MDR-TB patients that could not be explored in their analysis. They refer to a study from Moldova, where detailed analysis of 2007–2010 surveillance data showed that the positive association observed among new patients remained after adjustment for potential confounders [4]. We would like to refer to a similar analysis performed in Kazakhstan [5]. Using routine data from the electronic, national TB register from 2007–2011, we assessed patient characteristics associated with MDR-TB and/or HIV. In Kazakhstan, all patients are tested for HIV and TB drug resistance. HIV test results were available for 97% of TB patients and drug susceptibility test results for 93% of culture-positive patients. The proportion of TB patients with HIV increased from 0.6% in 2007 to 1.5% in 2011. The proportion of TB patients with multidrug resistance was high but did not change over time; on average, it was 36.1% for new and retreatment patients combined. In a crude analysis, among all 50 589 TB patients with HIV and drug susceptibility test results available, we observed a 20% higher prevalence of MDR-TB among HIV-positive patients than among HIV-negative patients (OR 1.2, 95% CI 1.02–1.4). Our results revealed that risk factors among TB patients for HIV and multidrug resistance were largely overlapping; in a univariate analysis, both included male sex, young adult age, urban residence, a history of incarceration, homelessness and drug abuse. Moreover, after adjustment for these overlapping risk factors in addition to demographics and treatment history, this association disappeared completely (adjusted OR 1.0, 95% CI 0.86–1.2). In addition, at the regional level, no clear association was observed between the prevalence of multidrug resistance and HIV (fig. 1). On average, 0.6% of the TB patients were infected both with HIV and MDR-TB Mycobacterium tuberculosis, but this risk varied greatly. TB patients at highest risk of being infected both with HIV and MDR-TB M. tuberculosis were those using drugs (12.5%) and those with a history of imprisonment (3.4%). These findings indicate that in Kazakhstan, the dual epidemic of HIV and MDR-TB is converging in specific socially vulnerable groups, and that enhanced efforts are necessary to provide (access to) diagnosis, TB/HIV treatment and care to these groups. This is important as both HIV and MDR-TB put patients at increased risk of treatment failure and mortality, and their combination is even more dangerous [6, 7]. Determinants of HIV and multidrug resistance are at least partly setting-specific and whether there is an independent association between them also may be situational. Therefore, it is important that more countries assess whether specific determinants may explain an apparent crude association between HIV and MDR-TB. This will require additional data collection beyond that available in routine surveillance registers in most settings.

FIGURE 1
  • Download figure
  • Open in new tab
  • Download powerpoint
FIGURE 1

Prevalence of multidrug resistance (MDR) and HIV among a) new and b) previously treated tuberculosis patients in Kazakhstan, 2007–2011.

Footnotes

  • Conflict of interest: None declared.

  • Received July 18, 2014.
  • Accepted August 12, 2014.
  • Copyright ©ERS 2015

References

  1. ↵
    1. Mesfin YM,
    2. Hailemariam D,
    3. Biadglign S, et al.
    Association between HIV/AIDS and multi-drug resistance tuberculosis: a systematic review and meta-analysis. PLoS One 2014; 9: e82235.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Suchindran S,
    2. Brouwer ES,
    3. Van Rie A
    . Is HIV infection a risk factor for multi-drug resistant tuberculosis? A systematic review. PLoS One 2009; 4: e5561.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Dean AS,
    2. Zignol M,
    3. Falzon D, et al.
    HIV and multidrug-resistant tuberculosis: overlapping epidemics. Eur Respir J 2014; 44: 251–254.
    OpenUrlFREE Full Text
  4. ↵
    1. Jenkins HE,
    2. Plesca V,
    3. Ciobanu A, et al.
    Assessing spatial heterogeneity of multidrug-resistant tuberculosis in a high-burden country. Eur Respir J 2013; 42: 1291–1301.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. van den Hof S,
    2. Tursynbayeva A,
    3. Abildaev T, et al.
    Converging risk factors but no association between HIV infection and multidrug-resistant tuberculosis in Kazakhstan. Int J Tuberc Lung Dis 2013; 17: 526–531.
    OpenUrlCrossRefPubMed
  6. ↵
    1. Wells CD,
    2. Cegielski JP,
    3. Nelson LJ, et al.
    HIV infection and multidrug-resistant tuberculosis: the perfect storm. J Infect Dis 2007; 196: Suppl. 1, S86–S107.
    OpenUrlCrossRefPubMedWeb of Science
  7. ↵
    1. Podlekareva DN,
    2. Panteleev AM,
    3. Grint D, et al.
    Short- and long-term mortality and causes of death in HIV/tuberculosis patients in Europe. Eur Respir J 2014; 43: 166–177.
PreviousNext
Back to top
View this article with LENS
Vol 45 Issue 2 Table of Contents
European Respiratory Journal: 45 (2)
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by author
Email

Thank you for your interest in spreading the word on European Respiratory Society .

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
HIV and multidrug-resistant tuberculosis: overlapping risk factors
(Your Name) has sent you a message from European Respiratory Society
(Your Name) thought you would like to see the European Respiratory Society web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Citation Tools
HIV and multidrug-resistant tuberculosis: overlapping risk factors
Susan van den Hof, Aigul Tursynbayeva, Tleukhan Abildaev, Malik Adenov, Svetlana Pak, Shakhimurat Ismailov
European Respiratory Journal Feb 2015, 45 (2) 567-569; DOI: 10.1183/09031936.00131014

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
HIV and multidrug-resistant tuberculosis: overlapping risk factors
Susan van den Hof, Aigul Tursynbayeva, Tleukhan Abildaev, Malik Adenov, Svetlana Pak, Shakhimurat Ismailov
European Respiratory Journal Feb 2015, 45 (2) 567-569; DOI: 10.1183/09031936.00131014
del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
Full Text (PDF)

Jump To

  • Article
    • Abstract
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

Subjects

  • Respiratory infections and tuberculosis
  • Tweet Widget
  • Facebook Like
  • Google Plus One

More in this TOC Section

Agora

  • Airway immune responses to COVID-19 vaccination in COPD patients
  • Wider access to rifapentine-based regimens is needed for TB care globally
  • Screening for PVOD in heterozygous EIF2AK4 variant carriers
Show more Agora

Correspondence

  • Treatable traits approach in interstitial lung disease
  • Reply: Treatable traits approach in interstitial lung disease
  • Reply: TB screening in migrants to the EU/EEA and UK
Show more Correspondence

Related Articles

Navigate

  • Home
  • Current issue
  • Archive

About the ERJ

  • Journal information
  • Editorial board
  • Press
  • Permissions and reprints
  • Advertising

The European Respiratory Society

  • Society home
  • myERS
  • Privacy policy
  • Accessibility

ERS publications

  • European Respiratory Journal
  • ERJ Open Research
  • European Respiratory Review
  • Breathe
  • ERS books online
  • ERS Bookshop

Help

  • Feedback

For authors

  • Instructions for authors
  • Publication ethics and malpractice
  • Submit a manuscript

For readers

  • Alerts
  • Subjects
  • Podcasts
  • RSS

Subscriptions

  • Accessing the ERS publications

Contact us

European Respiratory Society
442 Glossop Road
Sheffield S10 2PX
United Kingdom
Tel: +44 114 2672860
Email: journals@ersnet.org

ISSN

Print ISSN:  0903-1936
Online ISSN: 1399-3003

Copyright © 2023 by the European Respiratory Society