MDR-TB HIV co-infection among Injecting Drug Users

Dr Sugata Mukhopadhyay - CNS
Overall 10% of HIV infections globally, and excluding Africa nearly 30% of all new HIV infections are attributable to IDUs. About 20% of 15.9 million IDUs globally are infected by HIV. Drug Users have 10-30 times more chances of TB diseases and IDUs living with HIV have a 1 in 10 chance of TB disease per year as evidenced by scientific studies.

The countries with drug-use driven HIV epidemics like countries of Eastern Europe and Central Asia (60 – 75% of all HIV infections driven by IDUs) also have the highest rates of Multi Drug resistant-TB (MDR-TB). HIV-MDR TB association has been established in Latvia, Estonia, Moldova, Lithuania and Ukraine. IDUs make up 72% of Latvian HIV cases and comprise 81% of the country’s combined MDR-TB/HIV cases.

Air-borne transmission of MDR-TB in overcrowded HIV facilities and prisons is established which are home to many IDUs. 2 studies in Thailand showed MDR TB-HIV association with many IDUs in the studies; other than this no other study so far has established such association in Asian context. Overall, such studies raised doubt over a likely association between MDR-TB and HIV in limited set-ups in certain countries where the IDUs may remain at the receiving end of the most fatal MDR-TB and HIV co-infection.

Frequent migration, hidden nature and above all, continuing criminalized status of IDUs hamper adherence of TB treatment which might well lead to MDR-TB. Poor infection control in prisons and health facilities of IDUs may be a critical issue that needs to be properly investigated. All HIV prevention projects of IDUs (like Targeted Intervention, Needle Syringe Exchange Program, Oral Substitution Therapy, prisons) should be saturated with TB and infection control services through realistically designed TB/HIV collaborative initiatives. There is need of more scientific studies across the globe as well as Asia-Pacific region to detect the most fatal outcome of HIV infection in IDUs. Is it actually HIV-MDR TB co-infection?

Dr Sugata Mukhopadhyay, Citizen News Service - CNS
December 2013