Prostitution and HIV

Abstract

Between February 1993 and April 1994 at a pediatric unit and three adult units from two major hospitals in Bangui Central African Republic researchers randomly selected 530 tuberculosis (TB) patients to be part of a study of the interaction between HIV infection immunodepression and resistance to anti-TB drugs. Laboratory personnel were able to culture mycobacterial strains from 131 TB patients. 82% of the strains were Mycobacterium tuberculosis and 18% were M. africanum. 55.7% were HIV positive. The CD4 lymphocyte levels in 43% of the HIV positive patients with positive mycobacterial cultures were less than 200 x 1 million/l. 72.5% demonstrated sensitivity to all anti-TB antibiotics. 11.5% were resistant to only one anti-TB antibiotic (isoniazid streptomycin pyrazinamide streptomycin and ethambutol). 5.3% were resistant to more than one anti-TB antibiotic. The mycobacterial strains in 10.7% had multidrug resistance (isoniazid and rifampicin resistant). Even though the prevalence rate of resistant strains was similar for HIV positive and HIV negative (32.5% and 19.6% respectively) it was greater in TB patients (both HIV positive and HIV negative) with CD4 cell count of less than 200 x 1 million/l than for those greater than 200 x 1 million/l (44.4% vs. 15.6%; p < 0.001). These results show that mycobacterial strains resistant to anti-TB antibiotics are rather common in the Central African Republic suggesting the need for an effective National Tuberculosis Program. They suggest that immunodepressed patients (but not HIV per se) are more vulnerable to mycobacterial infection with resistant strains. Thus surveillance networks should be established to follow the prevalence of M. tuberculosis drug resistance to modify treatment strategies.