Volume 6 • Issue 5 • 1000377 J Pulm Respir Med, an open access journal ISSN: 2161-105X J o u r n a l o f P u l m o n a r y & R e s p ir a t o r y M e d i c i n e ISSN: 2161-105X Journal of Pulmonary & Respiratory Medicine Kalyan Kumar et al., J Pulm Respir Med 2016, 6:5 DOI: 10.4172/2161-105X.1000377 Research Article Open Access Prospective Study of Moxifloxacin prophylaxis in Patients Suffering with HIV Having Contact History of Multidrug Resistant Tuberculosis (MDR-TB) Kalyan Kumar PV 1 *, Ramakrishna Gorantla 2 and Ramakrishna Rachakonda 1 1 Department of Pulmonary Medicine, Katuri Medical College, Guntur, India 2 Department of General Medicine, Katuri Medical College, Guntur, India *Corresponding author: Kalyan Kumar PV, Department of Pulmonary Medicine, Katuri Medical College and Hospital, Guntur, India, Tel: +91-7093261025; E-mail: drpvkalyan@hotmail.com Received June 22, 2016; Accepted October 28, 2016; Published October 31, 2016 Citation: Kalyan Kumar PV, Ramakrishna G, Ramakrishna R (2016) Prospective Study of Moxifoxacin prophylaxis in Patients Suffering with HIV Having Contact History of Multidrug Resistant Tuberculosis (MDR-TB). J Pulm Respir Med 6: 377. doi: 10.4172/2161-105X.1000377 Copyright: © 2016 Kalyan Kumar PV, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Multi drug resistant tuberculosis; Tuberculosis; Human immunodefciency virus; Extensive drug resistant tuberculosis; Fluoroquinolone; Acquired immunodefciency syndrome; Antiretroviral therapy Introduction HIV/AIDS is a global pandemic. As of March 2016, 36.7 million (34.0 to 39.8 million) people globally were living with HIV. Nearly 2.1 million (1.8 to 2.4 million) people became newly infected with HIV. Despite the impressive roll-out of antiretroviral therapy (ART) programmes worldwide including in low and middle-income countries, 1.1 million (940,000 to 1.3 million) people died from AIDS related illnesses [1]. Tuberculosis (TB) is a leading killer of HIV-positive people: one in three HIV deaths was due to TB. At least one-third of people living with HIV worldwide were infected with TB bacteria. People living with HIV are 20 to 30 times more likely to develop active TB disease than people without HIV. HIV and TB form a lethal combination, each speeding the other’s progress. About 0.4 million people died of HIV associated TB. Approximately one third of deaths among HIV-positive people were due to TB [2]. According to World Health Organization (WHO), nearly 50% of the world’s burden of multi-drug resistant tuberculosis (MDR-TB) cases are present in India. Te situation of TB is further threatened by the overwhelming efect of human immunodefciency virus (HIV) on tuberculosis. Tuberculosis is one of the earliest opportunistic diseases to develop amongst persons infected with HIV and HIV infection is the most powerful risk factor of progression of TB [3]. Te 4 th World Health Organization report on anti-tuberculosis drug resistance, MDR-TB has been shown to be almost twice as common in TB patients living with HIV compared to TB patients without HIV [3]. Te intersection of the HIV and TB epidemics resulted in a dramatic upsurge in global TB incidence. In high income countries, all forms of TB are regarded as AIDS-defning conditions [4]. In contrast, the WHO staging system, separates pulmonary TB (stage 3) from extra pulmonary TB (stage 4 or AIDS) [5]. Since TB commonly occurs in non immunocompetent people, it is not surprising that TB occurs with a wide range of CD4 counts. Te CD4 count determines the incidence as well as the clinical and radiographic presentations of TB. HIV-infected patients are at greatly increased risk of developing active TB from reactivated latent tuberculosis infection (LTBI). HIV infection is also a risk factor for accelerated progression of TB following exposure, which has resulted in outbreaks of multidrug-resistant (MDR) and extensively drug-resistant (XDR-TB) [5]. Likewise, TB seems to have a negative impact on HIV disease, increasing the risk of progression to AIDS or death following TB treatment. Te acceleration of HIV diseases by TB may result from one or more of the following mechanisms: 1. TB infection is associated with signifcant increases in plasma HIV viremia. As is the case with other opportunistic infections. Persistently high levels of viremia have been observed in patients despite initiation of efective antitubercular therapy [6]. 2. Generalized immune activation, due to TB infection, may increase the proportion of CD4 cells that are preferential targets for HIV. Abstract Aim and Objectives: To fnd out the effectiveness of moxifoxacin prophylaxis in HIV patients having contact history of MDR-TB. Materials and Methods: This is an observational prospective cohort study of HIV patients divided in to two groups, moxifoxacin prophylaxis group and non-prophylaxis group. These groups are followed for four years from March 2012 to March 2016 to appraise the incidence of tuberculosis and mortality in these two cohorts. Results: The tuberculosis incidence in more in non-prophylaxis group when compared to prophylaxis group. Crude tuberculosis incidence is 275 per 1000 person/years in non-prophylaxis group when compared to 42 per 1000 person/ years in prophylaxis group (p<0.005). Incidence of MDR-TB is more in non-prophylaxis group (26 vs 6; p=0.002) when compared to prophylaxis group. Crude mortality rate is more in non-prophylaxis group (774 vs 103; p=0.003) when compared to the other group which was further confrmed by Cox regression hazards model. Proportional hazards model in which moxifoxacin prophylaxis had a 60% decrease in mortality compared to non-prophylaxis (adjusted relative hazard). Conclusion: Prophylaxis with 6-months moxifoxacin is an effective alternative for HIV patients instead of isoniazid suspected to contact with multidrug resistant tuberculosis.