Inroads Made Against Potent TB Strain

Extremely drug-resistant tuberculosis (XDR-TB) has cropped up in 49 countries, including the U.S. Its diagnosis is considered to be a virtual death sentence. But doctors in Peru are reporting cure rates almost as high as ordinary drug-resistant TB.

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Experts say they've been successful in treating a dangerous form of tuberculosis, a form that was thought to be untreatable. Every year, about a half million people around the world get forms of TB that don't respond to drugs.

NPR's Richard Knox reports on this new success.

RICHARD KNOX: Many people first heard about the problem a year ago. Health officials raised an alarm about a lawyer from Atlanta named Andrew Speaker. He flew to Europe and back with drug-resistant TB, potentially endangering fellow passengers. Officials initially thought Speaker had so-called extensively drug resistant TB, a type unfazed by almost all available drugs. He turned out to have a somewhat less resistant type, but the episode turned a spotlight on XDR-TB.

Many experts think XDR-TB is almost always fatal. But now, researchers are reporting substantial cure rates among patients in a poor area of Lima, Peru.

Carole Mitnick is a study author. She's with a Boston-based group called Partners in Health.

Dr. CAROLE MITNICK (Harvard Medical School; Partners in Health): Six hundred and fifty one patients were treated of whom 48 were diagnosed with extensively drug-resistant TB.

KNOX: Sixty percent of those patients were cured. The report is in this week's New England Journal of Medicine. In the 1990s, the conventional wisdom was that doctors should just treat regular TB properly and not bother with drug-resistant TB. Mitnick says back then, people said…

Ms. MITNICK: Even if you were to try to treat it, it's too expensive, it's too complicated, and it takes too long and would take resources away from the treatment of drug-susceptible TB.

KNOX: Mario Raviglione is the World Health Organization's chief of TB control. He says the new results will inspire people to try harder to treat XDR-TB.

Mr. MARIO RAVIGLIONE (Chief of TB Control, World Health Organization): It means that it's not a death sentence all the time. These data show that it is possible with aggressive treatment to achieve cure.

KNOX: Aggressive treatment means sending health workers to patients' homes once or twice a day for two years to make sure they take dozens of pills. It means dealing with toxic side effects so patients don't drop out. It means giving them psychological support and social support, even food and work. One big question - none of the study patients also had HIV. Many people around the world are infected with both TB and HIV.

But Dr. Jennifer Furin says there's hope for these patients as well. She works with Partners in Health in Lesotho, a tiny country surrounded on all sides by South Africa. The Lesotho group has treated nearly 200 patients infected with both HIV and extensively resistant TB.

Doctor JENNIFER FURIN (Country Director, Partners in Health Lesotho): They really are the hardest patients I've ever taken care of in my life, and they've done well for the most part. 60 percent live. And I was saying if we got any more than 30 percent who lived, I would consider it a success.

KNOX: That doesn't mean 60 percent are cured because they've only been treated for six months. But Furin thinks it's a harbinger.

Dr. FURIN: Two years from now, we'll say, 60 percent? No. We're up to 80. And I think that with hardworking people on the ground who believe in this, that that will be possible. And, you know, five years from now, people will be saying what they do about Peru. Well, we never thought it would happen, but look what happened.

KNOX: Meanwhile, Drew's Speaker, the Atlanta lawyer who caused such a fuss last year, says he's doing well in his bout with somewhat less drug-resistant TB. Like the patients in Lima and Lesotho, a health worker comes every day to make sure he takes his medicine.

Richard Knox, NPR News, Boston.

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