Highly Resistant TB Strains Appearing Among HIV-Positive People in South Africa, Study Says

Tuberculosis strains that are resistant to first- and second-line drugs -- known as XDR-TB -- have appeared among HIV-positive people in the South African province of KwaZulu-Natal, according to a study presented Thursday at the XVI International AIDS Conference in Toronto, the New York Times reports. Gerald Friedland of Yale University and colleagues examined the sputum samples of 536 people living with TB in the town of Tugela Ferry in the Msinga district of KwaZulu-Natal that were collected between January 2005 and March 2006. They found that 221 -- or 41% -- of the study participants had multi-drug resistant TB, and of these, 53 had XDR-TB. All of the people with XDR-TB were HIV-positive, the Times reports. According to study co-author Neel Gandhi of the Albert Einstein College of Medicine at Yeshiva University, most of the people with XDR-TB were carrying a genetically similar strain (Altman, New York Times, 8/18). According to the study, 52 of the 53 people with XDR-TB died, most within 30 days of having their sputum collected. The average survival period among the people with XDR-TB was 16 days, according to the researchers (Chase, Wall Street Journal, 8/17). According to Friedland, most of the participants who died had progressed to AIDS, and about half contracted the disease at hospitals or clinics. Because most of the people with XDR-TB had never been treated for TB, the researchers concluded that they did not develop resistance to treatment but had contracted the resistant strains from other people.

Implications
XDR-TB is a "potential time bomb," Friedland said, adding, "It's an extremely serious thing. I don't want to convey a sense of panic -- it's not Ebola. It's urgent, but it's not the same." According to Gandhi, there has been little research into the prevalence of XDR-TB in Africa or among HIV-positive people (New York Times, 8/18). He added that the emergence of XDR-TB in parts of Africa with high HIV prevalence could hinder the efficacy of antiretroviral drugs, as well as the DOTS strategy for treating TB, and undermine success in the fight against the two diseases. Peter Small, head of TB programs at the Bill & Melinda Gates Foundation, said that XDR-TB could be the "Achilles heel" of current treatment methods if increased efforts are not made to control it (Wall Street Journal, 8/17). Health officials from South Africa, the World Health Organization and other public health organizations plan to meet within the next few weeks to devise a plan for tackling XDR-TB, Friedland said (New York Times, 8/18).

Spread of TB Among HIV-Positive People Worldwide Undermines Effectiveness of Antiretrovirals, Experts Say
The spread of TB among HIV-positive people worldwide is undermining the effectiveness of antiretrovirals, experts at the AIDS conference said Wednesday, CP/CBC News reports. More than one-third of HIV-positive people worldwide also have TB, which causes the deaths of 250,000 HIV-positive people annually, Helene Gayle, co-chair of the conference and president of CARE, said. She called for the acceleration of prevention efforts that address both TB and HIV, saying that HIV-positive people should be guaranteed access to TB services and that all TB patients should be tested for HIV (Ubelacker, CP/CBC News, 8/16). Kevin De Cock, director of the World Health Organization's HIV/AIDS Department, called for TB management to be placed "at the head of AIDS management" (Berman, VOA News, 8/17). He added that unless the issue of TB/HIV coinfection is addressed aggressively, "we risk dealing with the specter of drug resistance and multi-drug resistance" (CP/CBC News, 8/16). Richard Chaisson, a professor of infectious diseases at Johns Hopkins University, said there is an urgent need for research into new TB drugs, diagnostics and vaccines for HIV-positive people, as well as studies and effective models to deliver the services to those who need them. Also at the conference, Lucy Chesire, an advocate from Kenya for HIV-positive people with TB, said HIV-positive people should urge their governments to allocate more resources to TB control and to ensure collaboration on TB and HIV activities (WHO/International AIDS Society release, 8/16).

Kaisernetwork.org is serving as the official webcaster of the conference. View the guide to coverage and all webcasts, interviews and a daily video round up of conference highlights at http://www.kaisernetwork.org/aids2006. A webcast of a session examining the relationship between HIV/AIDS and TB is available online.