Transmission of drug resistant tuberculosis in HIV endemic settings.
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.
The Lancet. Infectious diseases