Multidrug-resistant tuberculosis at an HIV testing center in Haiti

Objective: Tuberculosis is the major opportunistic infection of HIV/AIDS in developing countries. We investigated the prevalence rate of multidrug-resistant (MDR) tuberculosis at an HIV voluntary counseling and testing (VCT) center in Port-au-Prince, Haiti. Design and methods: A cross-sectional prevalence study of MDR-tuberculosis was conducted at a VCT Center. All patients reporting at least 5 days of cough were screened for tuberculosis, including sputum culture. All Mycobacteria tuberculosis isolates underwent drug susceptibility testing. Results: Between January 2000 and December 2002, isolates from 330 patients underwent drug susceptibility testing. MDR-tuberculosis was documented in 16 (6%) of 281 patients with primary tuberculosis and 10 (20%) of 49 patients with recurrent tuberculosis. In patients with primary disease, 11 (10%) of 115 HIV-infected patients had MDR-tuberculosis compared with five (3%) of 166 HIV-negative patients, (risk ratio 3.2; 95% confidence interval 1.1 -8.9; P = 0.0331). Conclusion: Multidrug resistance was prevalent among patients found to have pulmonary tuberculosis at an HIV testing center in Port-au-Prince. Patients with primary pulmonary tuberculosis who were HIV-co-infected were more likely to have multidrug resistance than HIV-negative patients. Assiduous attention to tuberculosis infection control measures at HIV testing centers in developing countries is critical to prevent nosocomial MDR-tuberculosis transmission. Measures may include appropriate ventilation, outdoor seating, ultra-violet lights, and rapid on-site screening for tuberculosis. (C) 2006 Lippincott Williams & Wilkins.