Abstract
During 1999 to 2000, we identified HIV-infected persons with new episodes of tuberculosis (TB) at 10 hospitals in Lima-Peru and a random sample of other Lima residents with TB. Multidrug-resistant (MDR)-TB was documented in 35 (43%) of 81 HIV-positive patients and 38 (3.9%)of 965 patients who were HIV-negative or of unknown HIV status (p < 0.001). HIV-positive patients with MDR-TB were concentrated at three hospitals that treat the greatest numbers of HIV-infected persons with TB. Of patients with TB, those with HIV infection differed from those without known HIV infection in having more frequent prior exposure to clinical services and more frequent previous TB therapy or prophylaxis. However, MDR-TB in HIV-infected patients was not associated with previous TB therapy or prophylaxis. MDR-TB is an ongoing problem in HIV-infected persons receiving care in public hospitals in Lima and Callao; they represent sentinel cases for a potentially larger epidemic of nosocomial MDR-TB.
Highlights
During 1999 to 2000, we identified HIV-infected persons with new episodes of tuberculosis (TB) at 10 hospitals in Lima, Peru, and a random sample of other Lima residents with TB
HIV infection influences the natural history of TB in several ways: active TB occurs within 6 months of acquiring Mycobacterium tuberculosis infection in 37% of persons
Drug-susceptibility testing was requested for all positive cultures and completed on 81, who were the focus of subsequent analyses; the remaining strains were lost before or during transport to the National Reference Laboratory for susceptibility testing
Summary
During 1999 to 2000, we identified HIV-infected persons with new episodes of tuberculosis (TB) at 10 hospitals in Lima, Peru, and a random sample of other Lima residents with TB. Nosocomial outbreaks of MDR-TB involving HIVinfected persons have occurred in the United States and other industrialized countries [6,7,8,9], but improved treatment and hospital infection control programs have contained these initial outbreaks of MDR-TB. Such outbreaks are increasingly recognized in countries with more limited resources [10,11]. TB was the AIDS-defining illness in 10,939 (28%) AIDS cases in Peru [13], and 50% of persons with AIDS in Peru develop TB at some point in their disease
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