Drug-resistant tuberculosis and HIV

Multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB are associated with substantially worse outcomes than drug-susceptible TB—especially in the setting of HIV co-infection. Although global TB incidence has decreased over the past decade, drug-resistant TB remains a substantial threat to control of TB worldwide. This chapter reviews the epidemiology of drug-resistant TB, common genetic mutations conferring resistance to first and second-line TB drugs, as well as current diagnostic methods and principles of treatment. Therapy for drug-resistant TB is complicated, associated with frequent side effects, and a field of active research. Several new and repurposed drugs, such as bedaquiline and delamanid, have recently come to market or are in active clinical development. Guidelines change frequently and consultation with a clinician who has expertise in the co-management of drug-resistant TB and HIV is recommended.