Resistant TB Strikes South Africans with HIV

A disturbing form of tuberculosis has shown up among people infected with HIV in South Africa. It's resistant to all known TB drugs and is usually fatal. Health experts are concerned it will spread. But they also say new forms of this superstrain can be prevented by distributing TB drugs along with anti-HIV drugs.

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ROBERT SIEGEL, host:

And I'm Robert Siegel.

The International Conference on HIV/AIDS wrapped up in Toronto today, and attendees left with disturbing news about HIV and tuberculosis. Around the world TB is the leading cause of death among people with HIV and the problem could be getting worse. Researchers at the conference described the outbreak of an untreatable type of TB among people who carry the AIDS virus.

NPR's Joanne Silberner reports.

JOANNE SILBERNER reporting:

Health experts have been dreading this. The evolution of tuberculosis bacteria into something drugs can't touch. The risk is greatest among people with HIV who have weakened immune systems. There have been sporadic reports of extremely drug resistant TB in people with HIV.

So Gerald Friedland of Yale University and an International group of researchers checked about 500 people with HIV and TB in South Africa over the past two years.

Mr. GERALD FRIEDLAND (Yale University): We found that among individuals who were co-infected with HIV and TB a substantial portion were affected with a strain of tuberculosis which is resistant to all available therapies, so that it's essentially untreatable. And the mortality from this has been close to 100 percent.

SILBERNER: Of the 53 people with the resistant TB, 52 died. Lee Rushman heads the Global TB Institute at the University of Medicine and Dentistry of New Jersey. He says the South Africa finding is no surprise.

Mr. LEE RUSHMAN (University of Medicine and Dentistry of New Jersey): The fact there is so many cases of extreme multiple drug resistant tuberculosis is something that had to happen. The reason it had to happen is that tuberculosis resistance is caused by people not taking their medicine properly or people not being treated properly.

SILBERNER: Most people don't get sick from regular TB and so far the new strain has been found only in people with HIV.

Richard Chasen, an HIV and TB expert at British John Hopkins University, says future outbreaks of extremely drug resistant TB can be prevented by eliminating regular TB, so that it doesn't evolve into the untreatable form. At the conference, he presented details of a successful study he worked on.

Mr. RICHARD CHASEN: We studied 12,000 HIV patients in Rio De Janeiro. We looked at the impact of giving both harsh anti retroviral treatment and TB preventive therapy and the combination of the two reduced the risk of TB by more than 75%.

SILBERNER: Prevention is one pill a day for six to nine months. Chasen says the total cost is literally pennies, and it's easy to add on to a HIV treatment program. And he says it needs to be done routinely.

Mr. CHASEN: All of the millions and millions and really billions of dollars that are being poured into expanding treatment for HIV run the risk of being undermined by failure to deal with tuberculosis.

SILBERNER: Yale's Gerald Friedman and others are also studying the best way to deal with TB and HIV. Whether they're able to do it effectively will be clear by the next HIV/AIDS International Conference two years from now in Mexico City.

Joanne Silberner, NPR News.

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