Transmission of drug-resistant tuberculosis in HIV-endemic settings.

The Lancet. Infectious diseases, Volume: 19, Issue: 3
March 13, 2019
Palwasha Y Khan PY, Tom A Yates TA, Muhammad Osman M, Robin M Warren RM, Yuri van der Heijden Y, Nesri Padayatchi N, Edward A Nardell EA, David Moore D, Barun Mathema B, Neel Gandhi N, Vegard Eldholm V, Keertan Dheda K, Anneke C Hesseling AC, Valerie Mizrahi V, Roxana Rustomjee R, Alexander Pym A

The emergence and expansion of the multidrug-resistant tuberculosis epidemic is a threat to the global control of tuberculosis. Multidrug-resistant tuberculosis is the result of the selection of resistance-conferring mutations during inadequate antituberculosis treatment. However, HIV has a profound effect on the natural history of tuberculosis, manifesting in an increased rate of disease progression, leading to increased transmission and amplification of multidrug-resistant tuberculosis. Interventions specific to HIV-endemic areas are urgently needed to block tuberculosis transmission. These interventions should include a combination of rapid molecular diagnostics and improved chemotherapy to shorten the duration of infectiousness, implementation of infection control measures, and active screening of multidrug-resistant tuberculosis contacts, with prophylactic regimens for individuals without evidence of disease. Development and improvement of the efficacy of interventions will require a greater understanding of the factors affecting the transmission of multidrug-resistant tuberculosis in HIV-endemic settings, including population-based molecular epidemiology studies. In this Series article, we review what we know about the transmission of multidrug-resistant tuberculosis in settings with high burdens of HIV and define the research priorities required to develop more effective interventions, to diminish ongoing transmission and the amplification of drug resistance.