Paul Thorn, 37, has a flair for the dramatic — understandably. In 1991, he was diagnosed with HIV. That was before anti-AIDS drugs. Thorn was constantly in and out of the hospital suffering from an infection. During one hospital stay on the AIDS ward, he became infected with multi-drug-resistant tuberculosis when the nurse induced another patient to cough up sputum.
"I'm the only survivor from that outbreak," Thorn says.
Like most people with compromised immune systems, people with HIV are particularly vulnerable to drug-resistant tuberculosis. Thorne spent three months in isolation in the hospital. Seeing images of Andrew Speaker in that mask brought back terrifying memories.
"For three months, I was cared for by people I didn't know what they looked like. All I could see were their eyes," Thorn recalls.
The nurses wore masks that covered everything but their eyes. And back then, Thorn says, the fear was such that no one wanted to come into his room. For Thorn, a gregarious man, the worst of the disease was the isolation. But he says it lived up to its old literary and historical reputation as "consumption."
"The weight loss was dramatic," Thorn says. "Raging night sweats. Cough. The taste of blood in my mouth."
Within time the symptoms disappeared but the treatments didn't. Thorn took about 30 pills a day and had one injection three times a week. The treatment lasted for three years.
"I used to feel that the drugs made me feel an awful lot worse than the disease itself," Thorn says. "Once I got to the point that I was not infectious — once I didn't have the fever, once I started putting on weight — the hardest part was continuing to take medication that made me feel rotten."
Dr. Mario Raviglione, WHO's director of TB control, says that failing to complete treatment contributes not only to resistance but to the spread of worse forms of the disease.
"TB is not a disease that can be easily undermined or forgotten. It is not something you treat, you give the antibiotics and you tell the patient go home and forget about it, because in a week time or two months time the patient may come back and be sick, having infected others," Raviglione says.
In Britain, Paul Thorne was monitored the whole time he was in treatment.
"After nearly three years, I was taken off treatment and declared cured. Since then, there's been no sight or sound of MDR tuberculosis. It's over 12 years now since I had it," Thorn says. "And in the meantime, we have anti-retroviral therapy, my HIV is fully managed. And indeed I lead a very full life."
The combination of HIV and TB led to one of the worst outbreaks of XDR-TB in the world — in South Africa — in which 52 out of 53 of the first patients died. Raviglione says that, unlike most African countries, South Africa has access to all TB drugs — and it has the world's largest HIV/AIDS epidemic.
"So the big concern is that XDR-TB in South Africa has emerged in people living with HIV-AIDS. And that by itself is a big problem because the evolution further of TB is much accelerated," he says.