an Eldis Resource
Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa
Assessing the prevalence and consequences of tuberculosis in South Africa
Authors:
N. R. Gandhi; A. Moll; A.W. Sturm
Publisher:
The Lancet, 2006
Tuberculosis is the most common cause of morbidity and mortality in individuals with HIV-1 infection in sub-Saharan Africa. HIV greatly increases the risk of active tuberculosis disease and about 80 per cent of patients presenting with active tuberculosis in the province of KwaZulu Natal, South Africa, are co-infected with HIV. This article in The Lancet considers an assessment of the prevalence and consequences of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis in a rural area in KwaZulu Natal, South Africa. The document outlines an enhanced surveillance for drug-resistant tuberculosis with sputum culture and drug susceptibility testing in patients with known or suspected tuberculosis.
The researchers found a substantially higher prevalence of XDR tuberculosis and MDR tuberculosis than previously reported. All patients with XDR tuberculosis who had previously been tested for HIV were co-infected with the virus. XDR tuberculosis disease in this population was rapidly, and almost uniformly, fatal. The authors argue that a rapid and comprehensive approach is essential to tackle this ominous situation. First, the full extent of MDR and XDR tuberculosis in areas of high HIV prevalence needs to be ascertained. Resources are needed to establish laboratory capacity capable of undertaking mycobacterial culture and drug susceptibility testing to facilitate timely diagnosis and to assess prevalence of drug resistance, in resource-limited settings. The document also recommends that treatment programmes must be strengthened to improve treatment completion rates and provide treatment for drug-resistant disease.
