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Rise of Multidrug-Resistant Tuberculosis in HIV Patients

Multidrug-Resistant Tuberculosis (MDR-TB) is defined as a strain of tuberculosis that has developed resistance to both isoniazid and, most importantly, rifampin, the most powerful bactericidal anti-tuberculosis medications presently available. The World Health Organization (WHO) declared multidrug-resistant tuberculosis (MDR-TB) a public health problem in 2013, and it continues to pose a serious threat to millions of people each year, especially HIV-positive people. TB is one of the top ten causes of death worldwide, with MDR-TB accounting for 15% of HIV-associated tuberculosis (TB) deaths in 2018. Furthermore, HIV patients are 20 times more likely than non-HIV patients to develop active tuberculosis.

Investigators include an updated pooled risk assessment of the relationship between HIV infection and MDR-TB development in a systematic review and meta-analysis published in BMC Infectious Diseases. After screening and rating the studies, the researchers looked at 54 studies that included 430,534 TB patients to find an unadjusted odds ratio (OR) that showed the correlation between HIV infection and MDR-TB. The average pooled OR was 1.42 (95 percent CI, 1.17-1.71), meaning that HIV patients are 42 percent more likely than HIV-negative patients to develop MDR-TB. This is a greater increase in risk than was observed in a previous meta-analysis of fewer reports, suggesting that HIV-infected people have been more likely to develop MDR-TB in the last decade.

MDR-TB is regarded as a major threat to tuberculosis control. The application and strengthening of DOTS, as well as the effective treatment of resistant cases, DOTS-Plus, are used to combat resistance. MDR-TB is also a major concern in many parts of the world. The Global Plan has suggested a three-pronged strategy for MDR-TB regulation. 

  1. extensive use of short-course chemotherapy; 
  2. enhanced resistance monitoring and surveillance; and 
  3. cautious implementation of second-line medications after comprehensive cost-effectiveness and efficacy assessments.

Multidrug-Resistant Tuberculosis necessitates the use of at least four effective drugs, while XDR-TB necessitates the use of as many active drugs as possible. Even in specialized management programs, HIV-infected and MDR- or XDR-TB patients have high mortality rates. The prognosis of such patients is improved by Sculpture. Such patients may be at higher risk of developing TB-IRIS due to the slow clearance of mycobacterial antigen load. Second-line anti-TB medications have a number of side effects that are similar to those seen with ART drugs. In those with MDR-TB, delays in starting ART should preferably be avoided due to the high mortality risk. New drug regimens are urgently needed. 

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