Quantifying the burden and trends of isoniazid resistant tuberculosis, 1994-2009

Quantifying isoniazid resistant (INH-R) tuberculosis (TB) is important because isoniazid resistance reduces the probability of treatment success, may facilitate the spread of multidrug resistance, and may reduce the effectiveness of isoniazid preventive therapy (IPT).

We used data reported to the World Health Organization between 1994-2009 to estimate the INH-R burden among new and retreatment TB cases. We assessed geographical and temporal variation in INH-R and reported levels in high HIV prevalence countries (≥2%) to understand implications for IPT. 131 settings reported INH-R data since 1994. A single global estimate of the percentage of incident TB cases with INH-R was deemed inappropriate due to particularly high levels in the Eastern European region where 44.9% (95% CI: 34.0%, 55.8%) of incident TB cases had INH-R. In all other regions combined, 13.9% (95% CI: 12.6%, 15.2%) of incident cases had INH-R with the lowest regional levels seen in West/Central Europe and Africa. Where trend data existed, we found examples of rising and falling burdens of INH-R. 40% of high HIV prevalence countries reported national data on INH-R and 7.3% (95% CI: 5.5%, 9.1%) of cases in these settings had INH-R.

Outside the Eastern European region, one in seven incident TB cases has INH-R, while this rises to nearly half within Eastern Europe. Many countries cannot assess trends in INH-R and the scarcity of data from high HIV prevalence areas limits insight into the implications for IPT. Further research is required to understand reasons for the observed time trends and to determine the effects of INH-R for control of TB.