A retrospective study of human immunodeficiency virus infection and drug-resistant tuberculosis in Durban, South Africa

SETTING: King George V hospital, a specialist referral hospital for tuberculosis (TB) patients in Durban, South Africa. OBJECTIVE: To investigate the relationship between drug-resistant TB and human immunodeficiency virus (HIV) infection. DESIGN: Retrospective descriptive study of 295 patient records, for the period January 1991 to April 1994, which were reviewed to collect data on HIV status, drug susceptibility and outcome as well as age, race, gender and previous TB treatment. RESULTS: Overall, 42 patients (14.2%) were HIV-seropositive while the rate of multidrug-resistant TB (MDR-TB) was 10.2%. Of those previously treated, 6.1% were HIV-seropositive while of those with no known history of previous TB, 5.4% were HIV-seropositive. A history of previous antituberculosis treatment was the strongest predictor for the presence of organisms resistant (Odds Ratio = 3.1; P = 0.0016) to one or more of the antituberculosis drugs. The prevalence of HIV infection was 13.1% in patients with drug-resistant TB and 14.9% in patients with drug-sensitive TB. CONCLUSION: The HIV epidemic has not exacerbated the occurrence of drug-resistant TB. History of previous TB treatment, and not HIV infection, was the principal factor associated with TB which is resistant to at least one primary anti-TB drug. However, as the HIV epidemic progresses in a milieu of high TB prevalence, the link with drug-resistant TB warrants constant monitoring and investigation.