Transmission of drug-resistant tuberculosis in HIV-endemic settings. Issue 3 (March 2019)

• Record Type: Journal Article
• Authors: Khan, Palwasha Y; Yates, Tom A; Osman, Muhammad; Warren, Robin M; van der Heijden, Yuri; Padayatchi, Nesri; Nardell, Edward A; Moore, David; Mathema, Barun; Gandhi, Neel; Eldholm, Vegard; Dheda, Keertan; Hesseling, Anneke C; Mizrahi, Valerie; Rustomjee, Roxana; Pym, Alexander
• Is Part Of: Lancet infectious diseases. Volume 19:Issue 3(2019)
• Page Start: e77
• Page End: e88
• Publication Date: 2019-03
• Subjects: Communicable diseases -- Periodicals; Infection -- Periodicals; Communicable Diseases -- Periodicals; Infection -- Periodicals; Maladies infectieuses -- Périodiques; Infection -- Périodiques; Communicable diseases; Infection; Periodicals; 616.905
• DOI: 10.1016/S1473-3099(18)30537-1
• Languages: English
• ISSNs: 1473-3099

Abstract

Summary: The emergence and expansion of the multidrug-resistant tuberculosis epidemic is a threat to the global control of tuberculosis. Multidrug-resistant tuberculosis is the result of the selection of resistance-conferring mutations during inadequate antituberculosis treatment. However, HIV has a profound effect on the natural history of tuberculosis, manifesting in an increased rate of disease progression, leading to increased transmission and amplification of multidrug-resistant tuberculosis. Interventions specific to HIV-endemic areas are urgently needed to block tuberculosis transmission. These interventions should include a combination of rapid molecular diagnostics and improved chemotherapy to shorten the duration of infectiousness, implementation of infection control measures, and active screening of multidrug-resistant tuberculosis contacts, with prophylactic regimens for individuals without evidence of disease. Development and improvement of the efficacy of interventions will require a greater understanding of the factors affecting the transmission of multidrug-resistant tuberculosis in HIV-endemic settings, including population-based molecular epidemiology studies. In this Series article, we review what we know about the transmission of multidrug-resistant tuberculosis in settings with high burdens of HIV and define the research priorities required to develop more effective interventions, to diminish ongoing transmission and the amplification of drug resistance.