Risk factors and algorithms to identify hepatitis C, hepatitis B, and HIV among Georgian tuberculosis patients.

OBJECTIVES: To determine prevalence, risk factors, and simple identification algorithms for HIV, hepatitis B, and hepatitis C co-infection; factors that may predispose for anti-tuberculosis therapy-induced hepatotoxicity. METHODS: We recruited 300 individuals at in-patient tuberculosis hospitals in three cities in Georgia, administered a behavioral questionnaire, and tested for antibody to HIV, hepatitis C (HCV), hepatitis B core antigen (anti-HBc), and the hepatitis B surface antigen (HBsAg). RESULTS: Of the individuals tested, 0.7% were HIV positive, 4.3% were HBsAg positive, 8.7% were anti-HBc positive, and 12.0% were HCV positive. In multivariable analysis, a history of blood transfusion, injection drug use, and prison were significant independent risk factors for HCV, while a history of blood transfusion, injection drug use, younger age at sexual debut, and a high number of sex partners were significant risk factors for HBV. Three-questionnaire item algorithms predicted HCV serostatus 74.1% of the time and HBV serostatus 85.2% of the time. CONCLUSIONS: Treatment of tuberculosis patients in resource-limited countries with concurrent epidemics of HCV, HBV, and HIV may be associated with significant hepatotoxicity. Serologic screening of tuberculosis patients for HBV, HCV, and HIV or using behavioral algorithms to identify patients in need of intensive monitoring during anti-tuberculosis therapy may reduce this risk.

High prevalence of hepatitis C virus but not HIV co-infection among patients with tuberculosis in Georgia.

SETTING: Tuberculosis (TB) and hepatitis C virus (HCV) infection have emerged as major public health problems in former Soviet republics. OBJECTIVE: To determine the prevalence and risk factors for the human immunodeficiency virus (HIV) and HCV co-infection among patients with TB in Georgia, a cross-sectional study was carried out at hospitals in four Georgian cities. RESULTS: Of 272 hospitalized patients with TB, 61 (22%) were found to be HCV-seropositive and three (1%) were HIV-seropositive. The median age of those with TB was 35 years (range 18-74 years); 74% were male. In multivariate analysis, risk factors for HCV co-infection included previous incarceration (OR 4.6, 95%CI 1.9-10.8), history of receiving a tattoo (OR 2.6, 95%CI 1.2-5.7), previous diagnosis of a sexually transmitted infection (OR 7.2, 95%CI 1.4-37.8), and age 26-45 years (OR 2.1, 95%CI 1.0-4.6). CONCLUSION: HCV co-infection was common among hospitalized patients with TB in Georgia. Incarceration and receiving a tattoo, a common practice among inmates in Georgian and former Soviet correctional facilities, were important independent risk factors associated with HCV infection among those with TB. Further studies are needed to assess the impact of the high prevalence of HCV co-infection on treatment outcomes, including tolerability and risk of anti-tuberculosis drug induced hepatotoxicity.

Molecular patterns of multidrug resistance of Mycobacterium tuberculosis in Georgia.

BACKGROUND: Tuberculosis (TB) infections caused by multidrug-resistant Mycobacterium tuberculosis (MDR MTB) remain a significant public health concern worldwide. Georgia has a high prevalence of MDR MTB. The genetic mechanisms underlying the emergence of MDR MTB strains in this region are poorly understood and need to be determined for developing better strategies for TB control. This study investigated the frequency of major drug resistance mutations across rpoB, katG and inhA loci of Georgian MDR MTB strains and explored differences between new and previously treated patients. A total of 634 MTB strains were examined for which an MDR phenotype had been previously determined by the proportions method. The GenoType®MTBDRplus system was applied to screen the strains for the presence of rpoB (S531L, H526D, H526Y, and D516V), katG (S315T) and inhA promoter region (C15T and T8C) mutations. The target loci were amplified by PCR and then hybridized with the respective site-specific and wild type (control) probes. RESULTS: Out of the 634 isolates tested considered by phenotypic testing to be resistant to RIF and INH, this resistance was confirmed by the GenoType®MTBDRplus assay in 575 (90.7%) isolates. RIF resistance was seen in 589 (92.9%) and INH resistance was seen in 584 (92.1%); 67.2% and 84.3% of MDR strains harbored respectively rpoB S531L and katG S315T mutations (generally known as having low or no fitness cost in MTB). The inhA C15T mutation was detected in 22.6% of the strains, whereas rpoB H526D, rpoB H526Y, rpoB D516V and inhA T8C were revealed at a markedly lower frequency (≤5.2%). The specific mutations responsible for the RIF resistance of 110 isolates (17.4%) could not be detected as no corresponding mutant probe was indicated in the assay. There was no specific association of the presence of mutations with the gender/age groups. All types of prevailing mutations had higher levels in new cases. A great majority of the Georgian MDR MTB strains have a strong preference for the drug resistance mutations carrying no or low fitness cost. Thus, it can be suggested that MDR MTB strains with such mutations will continue to arise in Georgia at a high frequency even in the absence of antibiotic pressure.

Prevalence and risk factors for drug resistance among hospitalized tuberculosis patients in Georgia.

BACKGROUND: Tuberculosis (TB) control in Georgia follows the World Health Organization-recommended DOTS strategy, and has reached global TB control targets in the treatment of susceptible TB; however, the management of drug-resistant forms of TB still represents a serious problem. A countrywide drug resistance survey (DRS) found that the prevalence of multidrug-resistant TB (MDR-TB) was respectively 6.8% and 27.4% in new and previously treated TB cases. OBJECTIVE: To determine the prevalence of and risk factors for drug resistance among TB patients to improve case management and control of drug-resistant TB. METHODS: Extensive social, clinical and bacteriological data were collected from patients hospitalized at the National Centre for Tuberculosis and Lung Diseases, Georgia, between 2005 and 2007. RESULTS: Of 605 patients, resistance was observed in 491 (81.2%); MDR-TB was found in 261 (43.1%; 51/222 [23%] new cases and 210/383 [55%] previously treated cases), monoresistant TB in 130 (21.5%), poly-resistant TB in 67 (11.1%) and extensively drug-resistant TB in 33 (5.5%). Female sex, living in the densely populated capital, family TB contact and previous TB treatment were associated with risk of MDR-TB. CONCLUSIONS: These findings confirm the necessity of improving infection control measures and of standardized treatment for drug-resistant TB patients.