AEGiS-14IAC: Impact of the growing HIV epidemic on control of multidrug resistant tuberculosis in Latvia.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Impact of the growing HIV epidemic on control of multidrug resistant tuberculosis in Latvia.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. MoOrC1104)

Wells CD, Priedulena I, Riekstina V, Sture G, Leimane V
Centers for Disease Control and Prevention, Atlanta, Georgia, United States

BACKGROUND: In the first World Health Organization (WHO) global survey of tuberculosis (TB) drug resistance in 1996, Latvia had the highest level of multidrug resistant (MDR) TB - resistance to at least isoniazid and rifampin - of all countries surveyed; 14.4% of newly diagnosed infectious TB cases were MDR TB. With successful implementation of the WHO-recommended DOTS strategy for TB control, a special treatment program for MDR TB, and basic measures to improve institutional infection control, MDR TB levels decreased by one-third to 9.3% by 2000. Now, an emerging HIV epidemic threatens gains made in controlling MDR TB.

METHODS: We reviewed national HIV screening data from the Latvian National AIDS Prevention Programme and from the National Tuberculosis Program for 1996-2001.

RESULTS: During 1996-2001, HIV seroprevalence increased 72-fold to 1264 cases per 100,000 persons screened, while the number and types of persons screened remained stable (~80,000 to 100,000 per year). Of the 1698 total HIV cases reported in the country, 72% were injection drug users (IDUs) and 68% were aged 16-29 years. During the same period with greater than 90% of all TB and MDR TB cases tested annually, HIV seroprevalence among TB cases increased from 0.1% to 1.3%. Of 49 total TB cases identified with HIV co-infection, 14 (28.6%) were MDR TB; of these, 11/14 cases (78.6%) were identified in 2001.

CONCLUSIONS: Though significant improvement has been achieved in Latvia since 1996 with the control of MDR TB, levels still remain high. Additionally, groups at increased risk for MDR TB and for HIV have a high degree of overlap. This overlap, coupled with infection control issues in institutions where MDR TB patients are treated, could amplify current levels of MDR TB. Therefore, containing HIV transmission, particularly among IDUs, is critical to the future of MDR TB control in Latvia.

Keywords: AEGIS, Tuberculosis, Multidrug-Resistant, Disease Outbreaks, HIV Infections, HIV Seropositivity, Infection Control, Tuberculosis, Cross Infection, HIV Seroprevalence, World Health Organization, Latvia, Greece, Human, prevention & control

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