Viral load for HIV treatment failure management: A report of eight drug-resistant tuberculosis cases co-infected with HIV requiring second-line antiretroviral treatment in mumbai, India

摘要

We read with great interest the report by Satti H, McLaughlin MM, and Seung KJ describing six HIV/drug-resistant tuberculosis (HIV/DR-TB) co-infected patients who failed first-line antiretroviral treatment (ART) in Lesotho.1 We would like to share an experience treating similar patients in Mumbai, India. Although having a lower HIV prevalence compared with many African countries, India has the third largest population living" with HIV, after South Africa and Nigeria, with an estimated 2,090,000 people affected in 2011.2 Furthermore, India has the highest burden of TB in the world, representing one-fifth (21%) of the global incidence. Unfortunately, India does not have national data on DR-TB prevalence, but a survey conducted in the States of Gujarat and Maharashtra in 2007 estimated the prevalence of DR-TB to be 3% in new cases and 12-17% in retreatment cases.Between October 2006 and July 2013, Medecins Sans Frontieres (MSF) treated 129 DR-TB patients co-infected with HIV at a clinic in Mumbai. The patients were referred to us from government ART centers, public-private ART centers, and a network of community non-governmental organizations. All HIV patients were monitored with viral load (VL) testing at least every 6 months, as recommended by Satti. Patients identified as having virological failure received adherence counseling and subsequently had the VL test rechecked at 3-6 months. Those in whom the VL test did not re-suppress were switched to a second-line ART regimen consisting of a protease inhibitor (PI) and suitable nucleoside(tide) reverse transcriptase inhibitors (NRTIs), based on genotype HIV resistance testing when necessary.