Incidence of multidrug-resistant pulmonary tuberculosis in HIV-positive patients A single-center observational study.

Abstract

Introduction: The objective of this study was to identify the incidence of multidrug-resistant pulmonary tuberculosis in HIV-reactive patients aged 20 to 64 years in the respiratory medicine department of the Guasmo Sur General Hospital (HGGS) from 2019 to 2020.

Methodology: This observational study was conducted at the Guasmo Sur General Hospital in Guayaquil, Ecuador, from January 2019 to December 2020. Records of patients over 19 years of age with HIV/multidrug-resistant pulmonary TB coinfections were included. Variables included age, sex, patient status, incidence, and mortality. Descriptive statistics were used.

Results: Ninety patients with coinfections were registered, of which 25 cases with multidrug resistance (27.8%) were analyzed. There were 23 men (92%), aged between 20 and 34 years (56%), and 21 living patients (84%). During 2019, there were 14 new cases of MDR-TB out of an at-risk population of 69 patients, which would indicate an incidence rate of 203 per thousand patients treated during this time period. In 2020, out of an at-risk population of 46 patients, there were 11 new cases of MDR-TB, which translates into an incidence rate of 239 per thousand patients.

Conclusions: Between 2019 and 2020, the incidence of multidrug-resistant tuberculosis (MDR-TB) in HIV-positive patients increased, from 203 to 230 cases per 1,000 patients. This risk was significantly higher in men, who recorded an incidence of 232 per 1,000 in 2019 and 256 per 1,000 in 2020, compared to women. Although the most affected age group shifted from the 35-64 age group in 2019 to the 20-34 age group in 2020, overall MDR-TB-associated mortality in this population also increased, from 143 to 182 deaths per 1,000 patients, suggesting a progressive worsening of clinical outcomes for coinfected patients.