HIV Fueling Deaths From XDR-TB in South Africa, Researchers Say
About 85% of HIV-positive South Africans coinfected with extensively drug-resistant tuberculosis, TB that is resistant to the two most potent first-line treatments and some of the available second-line drugs, have died -- a situation that presents one of the most pressing issues in global HIV and TB control -- researchers said on Sunday at the 14th Conference on Retroviruses and Opportunistic Infections in Los Angeles, the Los Angeles Times reports (Chong, Los Angeles Times, 2/26). According to Karin Weyer of South Africa's Medical Research Council, cases of XDR-TB have been found in 40 hospitals in South Africa, as well as in every province in the country. Weyer and her colleagues have found about 600 cases of XDR-TB in the country, the San Francisco Chronicle reports (Russell, San Francisco Chronicle, 2/26). XDR-TB has appeared in about 10% of people who had been diagnosed with multi-drug resistant TB in South Africa, according to Weyer (Los Angeles Times, 2/26). According to the Chronicle, XDR-TB does not seem to spread easily, but it does pose a threat to people and health care workers who are HIV-positive (San Francisco Chronicle, 2/26). Since September 2006, about 183 people, most of whom were HIV-positive, have died from XDR-TB in the country. XDR-TB could exacerbate the HIV/AIDS epidemic in South Africa, where about five million out of a population of 45 million people are HIV-positive and as many as 1,000 people die of AIDS-related complications daily (Kaiser Daily HIV/AIDS Report, 2/20). According to World Health Organization estimates, the number of countries with XDR-TB cases had increased from 17 in March 2006 to 28 currently. The most-affected countries include South Africa, South Korea and parts of Eastern Europe, according to CDC. XDR-TB "creates a huge challenge in terms of infection control, especially in settings where high numbers of HIV-positive individuals are converging," such as hospitals, Weyer said. Paul Nunn, coordinator of WHO's TB drug-resistance unit, at the conference said that the 85% mortality rate is "completely egregious" (Los Angeles Times, 2/26). It is important to increase awareness about XDR-TB worldwide "but without causing undue alarm," Nunn said. He added that the international community needs to spend $650 million annually on efforts to control various strains of MDR-TB, of which XDR-TB is one (San Francisco Chronicle, 2/26). Kevin Fenton, director of CDC's National Center for HIV, STD and TB Prevention, said that the XDR-TB cases in South Africa are a "wake-up call" for bolstering TB surveillance and prevention efforts. "We increasingly live in a small world," Fenton said, adding, "With foreign travel and migration to the U.S., we have to be very much aware of emerging threats of XDR-TB" (Los Angeles Times, 2/26).
Additional stories about XDR-TB are available on the Kaiser Family Foundation's GlobalHealthReporting.org information service.