Prevalence of Multi-Drug Resistant Tuberculosis among Patients with HIV and Tuberculosis: The Indian Scenario

Abstract

Introduction: Globally, India has the highest burden of tuberculosis (TB). In 2014, 2.2% of notified new cases and 15% of notified previously treated cases of pulmonary TB had multidrug resistant TB (MDR-TB). In addition, India has the second highest burden of people living with HIV and TB. However, there is paucity of data regarding the prevalence of multidrug resistant TB (MDR-TB) among HIV-positive TB patients in India. This study was undertaken to review the existing literature and assess the prevalence of MDR-TB among HIV-positive TB patients in the country. Methodology: A thorough PubMed and Google Scholar subject search was undertaken for studies conducted after the year 2000 that described the burden of MDR-TB in people living with HIV in India. The search-strategy used keywords, and was comprehensive with cross-checking of reference lists from the articles retrieved. Results: A total of 11 studies were collated that showed that the prevalence of MDR-TB among patients with HIV and TB varied widely between individual studies and ranged from 4.4% to 50%. Five studies showed that prevalence of MDR-TB among HIV-positive patients with primary TB ranged between 4.2%-11.4%. Among HIV-positive patients with pulmonary TB only, the MDR-TB prevalence ranged between 5.9% and 27.3%. In addition, prevalence of extensively drug-resistant TB (XDR-TB), ranged from 0% to 16.7% among HIV-positive TB patients. Conclusion: While the review showed no clear association between MDR-TB and HIV infection in India, there is a need for further research in this area. Scaling up of TB drug resistance testing facilities in the country will improve surveillance among people living with HIV and potentially provide programmatic trends on the burden of MDR-TB in HIV positive individuals in the future.