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 tuberculosis and associated risk factors, including HIV infection.

DESIGN

Prospective cohort study of patients with pulmonary tuberculosis.

SETTING

The study population comprised 28,522 men working on four goldmines in Westonaria, Gauteng. Health care is provided at a 240-bed mine hospital, Gold Fields West Hospital, and its primary health care facilities.

SUBJECTS: All 425 patients with culture-positive pulmonary tuberculosis identified in 1995.

OUTCOME MEASURES: Tuberculosis drug resistance on enrollment and after 6 months' 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%) was 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 multidrug resistance was 18.1%: 6.5% for recurrent disease and 33.9% in treatment failure cases. Neither HIV infection nor the degree of immunosuppression as assessed by CD4+ lymphocyte counts was associated with drug resistance at the start or end of treatment. New patterns of drug resistance were present 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 population and are not affected by the high prevalence of HIV infection.