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Threat posed by highly resistant strains of TB

An article published online this week in The Lancet warns that tuberculosis (TB) programs and HIV programs may face a threat from tuberculosis strains //that are resistant to both first-line and second-line drugs.

The study conducted by a team of researchers from the United States and South Africa reveals that highly resistant strains of TB that are responsible for increased death rates in HIV patients are widespread in a rural area of KwaZulu Natal, South Africa. TB claims nearly 1.7 million lives every year and is a major cause of death in HIV-infected patients in low-income countries.

In the study, presented by Dr. Neel Gandhi assistant professor of medicine at the Albert Einstein College of Medicine of Yeshiva University, the researchers tested patients with suspected tuberculosis for MDR and XDR strains. They found that of 1,539 patients, 221 had MDR tuberculosis, and 53 of these had XDR tuberculosis. The prevalence rates in a group of 475 patients with confirmed tuberculosis were 39% for MDR and 6% for XDR tuberculosis—higher rates than previously reported in the area. All patients with XDR disease who were tested for HIV were co-infected with the virus, and all but one died.

(Dr. Gandhi conducted this research while he completing fellowships at Yale University School of Medicine and Emory University. He joined the Einstein faculty in August 2006.) Further complicating the problem posed by multidrug-resistance is the fact that the epidemics of tuberculosis and HIV in South Africa are closely linked. Risk of tuberculosis disease is greatly increased in people with HIV infection, and multidrug-resistant (MDR) tuberculosis is emerging as a major cause of death in these patients. The term extensively drug-resistant (XDR) tuberculosis has recently been used to describe strains that are resistant to second-line drugs—i.e., drugs that are used if the recommended first drug treatment regimen fails.

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