Abstract:

Objective To investigate the MTB resistance rate, resistance spectrum and distribution of resistance genes in tuberculosis and HIV co-infection patients to provide guidance for clinical treatment. Methods A total of 263 patients with tuberculosis and HIV co-infection who met the inclusion and exclusion criteria in Chengdu Public Health Clinical Center from July 1, 2017 to June 30, 2019 were collected as the research objects. BACTEC MGIT 960 identification system was used for bacterial type identification, microplate proportion method was used for drug sensitivity test, and DNA microarray chip was used to detect drug resistance genes. The drug resistance rate,spectrum and gene distribution were analyzed among these patients. Results Among the 263 tuberculosis patients complicated with HIV infection, a total of 78 cases developed MTB resistance, with an overall drug resistance rate of 29.7%. The distributions of anti-tuberculosis drug resistance were as follows:INH (14.8%, 39/263),RFP (11.0%, 29/263),Sm (8.4%, 22/263),Mfx (6.5%, 17/263),Rfb (6.1%, 16/263),Lfx (4.6%, 12/263),EMB (4.2%, 11/263),Pto (3.4%, 9/263),PAS (3.0%, 8/263). The incidence of drug resistance in retreatment tuberculosis complicated with HIV infection was 57.4% (35/61), which was significantly higher than that in initial treatment tuberculosis complicated with HIV infection (21.3%, 43/202), and the difference was statistically significant (χ²=29.25,P=0.000). The drug resistance gene mutation of INH in katG were 24 strains (68.6%, 24/35) and 11 strains in inhA (31.4%, 11/35); the drug resistance gene mutation of RFP in rpoB 531 were 16 strains (61.5%, 16/26), 7 strains (26.9%, 7/26) in rpoB 526, and 3 strains (11.5%, 3/26) in rpoB 516. Conclusion The drug resistance rate of tuberculosis and HIV co-infection patients was higher, and distribution of the anti-tuberculosis drugs were mainly the first-line drugs. The rpoB531 mutations are the most common in RFP resistance, and katG mutations are common in INH resistance.

Key words: Tuberculosis, pulmonary, HIV infections, Comorbidity, Tuberculosis, multidrug-resistant, Genotype, Mutation, Research report