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Extensively Drug Resistant TB Spreads Across South Africa: Presented at CROI

By Ed Susman

LOS ANGELES, CA -- March 1, 2007 -- A dangerous and rapidly lethal form of extensively drug-resistant strain of tuberculosis (TB) has swept across South Africa, establishing itself in all 9 of the country's provinces, doctors said here at the 14^th Conference on Retroviruses and Opportunistic Infections (CROI).

"We still do not have a very good idea of how widespread the extensively dug-resistant tuberculosis is," noted Karin Weyer, MD, director of tuberculosis research, South Africa Medical Research Council, Pretoria, South Africa.

"We believe that there are about 6,000 cases of multidrug-resistant TB in South Africa, and when we treat these patients, about 10% fail to get better. Therefore, extrapolating from that, we calculate that there are about 600 cases of patients with extremely drug-resistant TB in South Africa," she added.

The extensively drug-resistant TB is especially worrisome for people who are co-infected with HIV. In these individuals, death can occur within a few weeks, Dr. Weyer said in a plenary lecture on February 25^th.

Last August, researchers at the World AIDS Conference reported an outbreak of the extensively drug-resistant TB killed 52 of 53 patients who were also co-infected with HIV. Those cases were reported in a rural hospital in KwaZulu province in South Africa.

When the disease is spread to others -- 6 health care workers were infected during the outbreak -- it is spread as a virtually untreatable disease, Dr. Weyer said. Four of those health care workers also had HIV infection, she said, and all of them died.

Since then the disease has made its way across the country, but has lost none of its virulence, especially in patients co-infected with HIV. About 29% of the nation has HIV infection.

"Extensively drug-resistant tuberculosis represents the failure of tuberculosis control at the global level," Dr. Weyer said.

The outbreak of extensively drug-resistant TB is not limited to South Africa, commented Paul Nunn, MD, director, Stop TB program, World Health Organisation, Geneva, Switzerland.

Dr. Nunn said that nearly 9 million people worldwide have TB, a disease that kills 1.6 million people each year. He estimated that there are likely 16,000 deaths worldwide among individuals infected with the extensively drug-resistant organism. Such strains now have been reported in 28 countries, including the United States, Dr. Nunn said. However, the bulk of the resistant strains are found in China, India and Russia.

"Extensively drug-resistant TB is a wake-up call for strengthening basic tuberculosis and HIV care, prevention and control, and scaling up the management of drug-resistant tuberculosis," Dr. Nunn said.

He estimated that a worldwide expenditure of $650 million a year will be required to control extensively drug-resistant TB.


[Presentation title: Transmission of Extensively Drug Resistant TB in South Africa and Implications for Infection Control in Health Care Settings. Abstract 8]

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