HIV amplifies risk of multidrug-resistant TB

The risk of being infected with multidrug-resistant tuberculosis (MDR-TB) is higher among people living with HIV, particularly in Southeast Asia, according to a recent meta-analysis.

“The meta-analysis clearly shows a growing trend in MDR-TB risk among HIV-infected people. Balanced resource allocation for Asian, European, and African countries should be considered to halt both primary and secondary MDR-TB, especially among those with increasing age,” the researchers said.

Searching through the databases of PubMed, Google Scholar, and Science Direct, the researchers retrieved 54 studies eligible for quantitative synthesis, corresponding to a total of 430,534 TB patients. Studies spanned 36 countries across all WHO regions, and almost half were from the African region. Funnel plots and Egger’s test were used to assess methodological quality.

Overall, patients with HIV were 42-percent more likely to contract MDR-TB than those without HIV (odds ratio [OR], 1.42, 95 percent confidence interval [CI], 1.17–1.71). This pooled analysis showed no significant evidence of publication bias (p=0.36). [BMC Infect Dis 2021;21:51]

Stratifying according to geographical location, the researchers found very similar estimates for the African region, where people with HIV were at a 41-percent greater risk of MDR-TB (OR, 1.41, 95 percent CI, 1.06–1.89). The risk was greatest among Southeast Asian countries, where MDR-TB was nearly 90-percent more likely to occur among people with HIV (OR, 1.86, 95 percent CI, 1.30–2.67).

Subsequent subgroup analyses showed that people living in high-income countries (OR, 1.26, 95 percent CI, 0.86–1.86) were slightly more protected from the effects of HIV on MDR-TB risk, as opposed to those residing in low-income countries (OR, 1.40, 95 percent CI, 0.99–1.98).

Similarly, living in countries with a low TB burden seemed to completely eliminate the interaction between HIV and MDR-TB (OR, 1.0, 95 percent CI 0.72–1.39). People with HIV in countries with high TB burden, however, suffered from high risk estimates (OR, 1.75, 95 percent CI, 1.39–2.19).

Age also emerged as an important factor. HIV had a stronger aggravating effect on MDR-TB risk in patients aged ≥40 years (OR, 1.56, 95 percent CI, 1.17–2.06) than in those <40 years (OR, 1.45, 95 percent CI, 1.11–1.91).

“MDR-TB is a form of TB that does not respond to at least isoniazid and rifampicin, the two most potent anti-TB drugs,” the researchers explained. “The surge of MDR-TB occurrence in HIV-prevalent settings is of great public health importance.”

“As such, the enhancement of the diagnosis and proper overall management of MDR-TB among HIV-positive individuals has become crucial in achieving WHO’s goals of ‘End TB’ by 2035,” they added.