High incidence of drug-resistant Mycobacterium tuberculosis in Hainan Island, China.

OBJECTIVES: To assess the proportion of drug-resistant tuberculosis (TB) cases and to identify independent risk factors associated with drug-resistant TB in Hainan. METHODS: Descriptive analysis of demographic and clinical data of culture-positive TB patients to assess the trends in drug-resistant TB at the Provincial Clinical Center on Tuberculosis of Hainan between 2014 and 2017. RESULTS: 994 patients were recruited into the study. Overall, the proportion of patients resistant to at least one TB drug tested was 36.1% (359/994). The most frequent resistance was to isoniazid (INH, 29.8%), followed by rifampin (RIF, 29.3%), streptomycin (19.3%), ofloxacin (OFX, 17.4%), ethambutol (9.5%) and kanamycin (KAN, 3.2%). Of 291 RIF-resistant isolates, 228 (78.4%) were also resistant to INH, while the remaining 63 (21.6%) were susceptible to INH. Among those with multidrug-resistant tuberculosis (MDR-TB), 41.2% had additional resistance to OFX and 3.9% to KAN. 8.8% of MDR-TB patients were affected by extensively drug-resistant (XDR-TB). Females were more likely to infected with MDR-TB than males, and young people (<20 years old) were more likely to have MDR-TB; patients exhibited decreasing MDR-TB risk with increasing age. CONCLUSIONS: Our data provide the first primary understanding of the drug-resistant TB epidemic in Hainan. The high incidence of drug resistance, especially RIF and FQ resistance, highlight the importance of interventions for preventing epidemics of drug-resistant TB. Younger age is an independent predictor of MDR-TB, reflecting the potential transmission in this population.

OBJECTIFS: Evaluer la proportion de cas de tuberculose (TB) résistante aux médicaments et identifier les facteurs de risque indépendants associés à la TB résistante à Hainan. MÉTHODES: Analyse descriptive des données démographiques et cliniques de patients TB à culture positive pour évaluer les tendances de la TB résistante au Centre Clinique Provincial de la TB de Hainan entre 2014 et 2017. RÉSULTATS: 994 patients ont été recrutés dans l'étude. Au total, la proportion de patients résistant à au moins un antituberculeux testé était de 36,1% (359/994). La résistance la plus fréquente était à l'isoniazide (INH, 29,8%), suivi par la rifampine (RIF, 29,3%), la streptomycine (19,3%), l'ofloxacine (OFX, 17,4%), l'éthambutol (9,5%) et la kanamycine (KAN, 3,2%). Sur les 291 isolats résistants au RIF, 228 (78,4%) étaient également résistants à l'INH, tandis que les 63 restants (21,6%) étaient sensibles à l'INH. Parmi ceux avec la multirésistance (TB-MDR), 41,2% présentaient une résistance supplémentaire à l'OFX et 3,9% à la KAN. 8,8% des patients atteints de TB-MDR étaient atteints d'une TB ultrarésistante (TB-XDR). Les femmes étaient plus susceptibles d'être infectées par la TB-MDR que les hommes et les jeunes (<20 ans) étaient plus susceptibles d'être atteints de TB-MDR; les patients présentaient un risque décroissant de TB-MDR avec l'âge. CONCLUSIONS: Nos données fournissent la première compréhension importante de l'épidémie de TB résistante à Hainan. L'incidence élevée de la résistance aux médicaments, en particulier des résistances RIF et FQ, souligne l'importance des interventions pour prévenir les épidémies de TB résistante. L'âge plus jeune est un facteur indépendant de prédiction de la TB-MDR, reflétant le potentiel de transmission dans cette population.

Incidence, risk factors and causes of death in an HIV care programme with a large proportion of injecting drug users.

OBJECTIVES: To identify factors influencing mortality in an HIV programme providing care to large numbers of injecting drug users (IDUs) and patients co-infected with hepatitis C (HCV). METHODS: A longitudinal analysis of monitoring data from HIV-infected adults who started antiretroviral therapy (ART) between 2003 and 2009 was performed. Mortality and programme attrition rates within 2 years of ART initiation were estimated. Associations with individual-level factors were assessed with multivariable Cox and piece-wise Cox regression. RESULTS: A total of 1671 person-years of follow-up from 1014 individuals was analysed. Thirty-four percent of patients were women and 33% were current or ex-IDUs. 36.2% of patients (90.8% of IDUs) were co-infected with HCV. Two-year all-cause mortality rate was 5.4 per 100 person-years (95% CI, 4.4-6.7). Most HIV-related deaths occurred within 6 months of ART start (36, 67.9%), but only 5 (25.0%) non-HIV-related deaths were recorded during this period. Mortality was higher in older patients (HR = 2.50; 95% CI, 1.42-4.40 for ≥40 compared to 15-29 years), and in those with initial BMI < 18.5 kg/m(2) (HR = 3.38; 95% CI, 1.82-5.32), poor adherence to treatment (HR = 5.13; 95% CI, 2.47-10.65 during the second year of therapy), or low initial CD4 cell count (HR = 4.55; 95% CI, 1.54-13.41 for <100 compared to ≥100 cells/µl). Risk of death was not associated with IDU status (P = 0.38). CONCLUSION: Increased mortality was associated with late presentation of patients. In this programme, death rates were similar regardless of injection drug exposure, supporting the notion that satisfactory treatment outcomes can be achieved when comprehensive care is provided to these patients.