Drug-resistant pulmonary tuberculosis in a cohort of Southern African goldminers with a high prevalence of HIV infection

Objectives. To determine rates of drug resistance to Mycobacterium tubercul osis and associated risk factors, including PW infection. Design. Prospective cohort study of patients with pulmonary tuberculosis. Setting. The study population comprised 28 522 men working on four goldmine s in Westonaria, Gauteng. Health care is provided at a 240-bed mine hospita l, Gold Fields West Hospital, and its primary health care facilities. Subjects. All 425 patients with culture-positive pulmonary tuberculosis ide ntified in 1995. Outcome measures. Tuberculosis drug resistance on enrolment and after 6 mon ths' treatment. Results. There were 292 cases of new tuberculosis, 77 of recurrent disease and 56 prevalent cases in treatment failure. Two hundred and seven patients (48.7%) were HIV infected. Primary resistance to one or more drugs (9%) wa s similar to the 11% found in a previous study done on goldminers in 1989. Primary multidrug resistance (0.3%) was also similar (0.8%). Acquired multi drug resistance was 18.1%: 6.5% for recurrent disease and 33.9% in treatmen t failure cases. Neither HIV infection nor the degree of immunosuppression as assessed by CD4+ lymphocyte counts was associated with drug resistance a t the start or end of treatment. New patterns of drug resistance were prese nt in 9 of 52 patients in treatment failure at 6 months, 1 of whom was HIV- infected. Conclusion. Primary and acquired drug resistance rates are stable in this p opulation and are not affected by the high prevalence of HIV infection.