Third International Congress Drug Therapy in HIV Infection 3-7 November 1996 Glasgow, UK

THE CONTROL OF MULTIPLE DRUG RESISTANCE IN TUBERCULOSIS: NEW INSIGHTS AND OLD STRATEGIES FOR THE HIV EPIDEMIC

Michael L. Tapper, MD
Section of Infectious Diseases and AIDS Center Program, Lenox Hill Hospital, New York, NY USA

Int Cong Drug Therapy HIV 1996 Nov 3-7;3:Abstract No. 7.1
AIDS 1996, Vol. 10 (Suppl. 2);S5

In 1995, 2445 new cases of tuberculosis were reported in NYC, representing a 35.8% decrease from 1992 at the peak of the current epidemic. The 1995 NYC TB case rate remains the highest in the USA, four times the national rate. 109 patients had multidrug resistant strains (MDR TB), a 75.3% decrease from 1992. Directly observed therapy (DOT) and enhanced institution-al infection control programs were responsible for the observed decreases in case rates and multiple drug resistance respectively. Of 109 patients with MDR TB, 22% were foreign born and 76% were US born. Only 8.3% of MDR TB cases were known to have previously been treated for TB suggesting that ongoing transmission of MDR isolates accounts for most new MDR cases. HIV status was known for two-thirds of these cases; half of patients tested were HIV positive. Fewer foreign born patients than US born patients with TB were likely to be HIV tested. Infection control strategies to prevent the dissemination of tuberculosis in institutional settings remain controversial in the US although nosocomial out-breaks of tuberculosis in HIV congregate settings continue to be reported despite widespread publicity about prior US outbreaks. New challenges and areas of controversy in managing dually infected HIV/TB patients include adverse drug interactions between rifampin and protease inhibitors, and the potential contribution of rifabutin for MAC prophylaxis to subsequent development of rifampin resistance in MTB.

Presenting author: Michael L. Tapper, MD

1996-11-03
7.1

Originally published in AIDS Volume 10, Supplement 2 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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