The association between HIV and anti-tuberculosis drug resistance in England and Wales

In the UK, HIV is considered to be a risk factor for anti-tuberculosis drug resistance. Evidence on the association is, however, inconclusive and there is little population level data. This study investigated the association in England and Wales during 1999-2005. National tuberculosis surveillance data for adults were matched to HIV/AIDS reports. Unmatched cases were assumed to be HIV-negative. Separate analyses were conducted on new tuberculosis cases and those with a previous diagnosis. Logistic regression was used for univariable and multivariable analyses. There were 1657 previously diagnosed cases (80 HIV-positive) and 18,130 new cases (1156 HIV-positive). Isoniazid resistance was found in 8.1% of previously diagnosed cases and 6.6% of new cases, and multidrug resistance (MDR) in 2.8% and 0.7% respectively. There was no evidence of an association between HIV and anti-tuberculosis drug resistance among previously diagnosed cases. Among new cases, there was no overall association between HIV and isoniazid resistance or MDR after adjusting for confounding factors. White HIV-positive patients were more likely to have MDR, but numbers were small. In contrast to some previous studies, this large up-to-date study provides little evidence that HIV co-infected tuberculosis patients in England and Wales are at increased risk of first-line anti-tuberculosis drug resistance.