Characteristics of drug resistance and HIV among tuberculosis patients in Mozambique

SETTING: The rate of human immunodeficiency virus (HIV) seroprevalence amon g tuberculosis patients varies between 2% and 53% in Mozambique, depending on the region. Drug resistance surveillance has been performed in only a fe w cities in Mozambique. OBJECTIVES: To establish the extent of drug resistance in areas of Mozambiq ue with different levels of HIV prevalence, to estimate the prevalence of H IV among tuberculosis (TB) patients, and to examine the association between drug resistance and HIV infection. DESIGN: All tuberculosis patients diagnosed at randomly selected health fac ilities over 9 months (September 1998 to June 1999) were enrolled in the st udy. Sputum was collected, smeared and cultured, and drug susceptibility te sts were performed. Blood was tested for HIV in the respective provinces, a nd patients received pre-test and post-test counselling. RESULTS: Of 709 culture-positive cases, 25.5% were HIV-positive. HIV-positi ve patients were significantly more likely to have a prior history of treat ment (OR 2.2; 95%CI 1.9-3.6) and resistance to both isoniazid and streptomy cin (OR 2.3; 95 % CI 1.3, 4.5). In patients with no history of prior tuberc ulosis treatment, the multidrug resistance rate was 3.4% and resistance to isoniazid and streptomycin (HS) was 5.2%. Any drug resistance was significa ntly more common among those with a history of prior treatment (OR 3.1; 95% CI 2.1-4.7), particularly resistance to HS (OR 4.5; 95%CI 2.6-7.9). CONCLUSIONS: This study demonstrates substantial levels of drug resistance in Mozambique. Differences in drug resistance between high and low HIV prev alence areas may be related to prior treatment.