Drug-Resistant TB Outbreaks in Africa, Ukraine Not Diminishing, Scientists Say
Outbreaks of drug-resistant tuberculosis in Africa and Eastern Europe that are often complicated by HIV/AIDS show no signs of slowing, researchers reported last week at the 15th Conference on Retroviruses and Opportunistic Infections in Boston, Reuters Health reports. Two teams of scientists presented studies at the conference about outbreaks of drug-resistant TB among HIV-positive people in South Africa and Ukraine.
South Africa Study
Neel Gandhi of the Albert Einstein College of Medicine and colleagues examined an outbreak of extensively drug-resistant TB -- which is resistant to the two most potent first-line treatments and some of the available second-line drugs -- and multi-drug resistant TB among HIV-positive people in South Africa's KwaZulu-Natal province. According to Gandhi, people who are HIV-positive people are "canaries in the mines" because they are among the first to exhibit symptoms of MDR-TB.
Between 2005 and 2006, Gandhi and colleagues evaluated 17 people with HIV/TB coinfection who began to show signs of drug-resistant TB. They observed that those with HIV/TB coinfection would develop drug-resistant TB soon after receiving successful treatment for drug-sensitive TB. The source of reinfection often was a new strain rather than a mutation from the original strain, the researchers found. Fifteen of the 17 people in the study died within weeks of being diagnosed with drug-resistant TB. Gandhi said the findings highlight the need for infection control to curb outbreaks.
In the second report, Matteo Zignol of the World Health Organization's project office in Donetsk, Ukraine, and colleagues evaluated all new and previous TB cases over a one-year period in the country. The team examined about 1,500 cases of TB, two-thirds of which were new and one-third of which occurred among people who had received previous TB treatment. Twenty-one percent of people also were living with HIV. The researchers found that 15.5% of the new TB cases were MDR-TB, one of the highest rates reported in a population study, Reuters Health reports.
The team also found that HIV was a reliable indicator of MDR-TB. Death rates from TB also were significantly higher among HIV-positive people. Separate risk factors included a history of incarceration and previous TB treatment, the findings showed. According to Zignol, the study's most important implication is the need to improve preventive procedures, especially in prisons and hospitals. Zignol said the study will be submitted to the Ukrainian government with recommendations for changes in public health policy. He added that he is "quite optimistic" the government will consider the recommendations (Mitchell, Reuters Health, 2/7).