DRUG-RESISTANT TUBERCULOSIS IN HUMAN-IMMUNODEFICIENCY-VIRUS INFECTED PERSONS IN ITALY

OBJECTIVE: To describe the prevalence and epidemiological-clinical cha racteristics of tuberculosis (TB) resistance to first-line drugs in It alian human immunodeficiency virus (HIV)-infected subjects. DESIGN: Pr ospective, observational multicenter (25 Centers of Infectious Disease s) study. Mycobacterium tuberculosis strains from 167 HIV co-infected subjects with TB (149 new cases, 18 relapses) were tested at a central laboratory for susceptibility to rifampin (R), isoniazid (H), pyrazin amide (Z), ethambutol (E) and streptomycin (S) and for DNA fingerprint type. Drug susceptibility results were related to patients' epidemiol ogical, clinical and laboratory features. RESULTS: Drug resistance pat terns among new TB cases were as follows: R = 1%, Z = 6%, S = 8%, H S = 3%, S + Z = 4%. TB resistant to at least R + H (MDR-TB) was detect ed in 36% of new cases due to an MDR-TB outbreak which was the largest thus far in Europe, involving 7/25 participating institutions, and wa s demonstrated by conventional and molecular epidemiology evidence. Wi th multivariate analysis, MDR-TB was associated with hospital exposure to MDR-TB (OR = 39.3, P < 0.001) and previous use of anti-TB drugs (O R = 9.8, P = 0.008). CONCLUSION: As drug-resistant tuberculosis in Ita ly is thus far relatively scarce, detection of a large MDR-TB epidemic among HIV-infected subjects was alarming. Aggressive control measures are urgently needed to prevent the spread of MDR-TB throughout the co untry and among the general population.