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Rifampin monoresistant tuberculosis and HIV comorbidity in California, 1993–2008: a retrospective cohort study

Prach, Lisa M.a; Pascopella, Lisab; Barry, Pennan M.b; Flood, Jenniferb; Porco, Travis C.c; Hopewell, Philip C.d; Metcalfe, John Z.d

doi: 10.1097/01.aids.0000432445.07437.07
Epidemiology and Social

Objective: Rifampin monoresistant tuberculosis (RMR-TB) is increasingly identified because of scale-up of rapid molecular tests. The longitudinal association of RMR-TB, multidrug-resistant TB (MDR-TB), and HIV/AIDS is incompletely described.

Methods: We examined clinical characteristics and treatment outcomes of patients with RMR-TB, isoniazid monoresistant TB (IMR-TB), MDR-TB, and drug-susceptible TB during a 16-year period (1993–2008) in California. TB cases were cross-matched with the state HIV/AIDS registry, and HIV prevalence denominators modeled using nonparametric backcalculation.

Results: Of 42 582 TB cases, 178 (0.4%), 3469 (8.1%), and 635 (1.5%) were RMR-TB, IMR-TB, and MDR-TB, respectively. From the pre-HAART (1993–1996) to HAART (2005–2008) era, RMR-TB rates declined rapidly (12.0 vs. 0.5 per 100 000) among patients with HIV infection. The proportion of patients for whom rifampin resistance indicated RMR-TB (rather than MDR-TB) decreased from 31% [95% confidence interval (CI) 26–38%] to 11% (95% CI 5–19%). In multivariate analysis controlling for HIV coinfection and other covariates, patients with RMR-TB were twice as likely to die as patients with drug-sensitive TB (relative risk 1.94, 95% CI 1.40–2.69).

Conclusion: RMR-TB/HIV rates declined substantially over time in association with improved TB control and HIV control in California. Mortality among patients with RMR-TB was high, even after adjusting for HIV status.

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aCenter for AIDS Prevention Studies (CAPS), University of California, San Francisco

bTuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond

cF.I. Proctor Foundation, University of California, San Francisco

dCurry International Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA.

Correspondence to John Z. Metcalfe, MD, PhD, MPH, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Rm 5K1, San Francisco, CA 94110-0111, USA. E-mail:

Received 30 May, 2013

Accepted 11 June, 2013

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© 2013 Lippincott Williams & Wilkins, Inc.