The regions of the world with the fastest growing HIV epidemics also have the highest rates of multidrug-resistant tuberculosis (MDR-TB), according to a World Health Organisation (WHO) report published on March 16th. In particular, many of the former Soviet republics, China, and South Africa were identified as key areas with a particularly high prevalence of MDR-TB.
TB is classified as multidrug-resistant if two of the first-line antibiotics used in its treatment, isoniazid and rifampicin, are ineffective.
WHO found that the highest prevalence of MDR-TB coincided with the world’s fastest growing HIV epidemics, in the former Soviet republics and parts of eastern Europe. Elevated rates of MDR-TB were also observed in China, which also has an exploding HIV epidemic, and in South Africa. In eastern Europe and central Asia, rates of MDR-TB are ten times higher than in the rest of the world, and in provinces of China where TB surveillance programmes have been initiated, one in ten TB patients were found to be infected with MDR-TB, and many of these individuals were also HIV-positive.
The ability of MDR-TB to work in synergy with HIV was emphasised by Dr Jack Crow, Assistant Director General at WHO with responsibility for HIV, TB and malaria control. “With people’s immune systems compromised, MDR-TB has a perfect opportunity to spread rapidly and kill,” he said.
There is also some good news in the report. Successful control of MDR-TB outbreaks in Cuba, Hong Kong and the USA is praised, and WHO emphasises the importance of the directly observed therapy short course (DOTS) strategy for controlling TB worldwide. In parts of Russia with particularly bad MDR-TB problems, an enhanced version of this strategy called DOTS-plus has shown some success and is praised by WHO. However, earlier this year Medicine Sans Frontieres withdrew from TB treatment and control programmes in Siberian prisons because of a lack of cooperation from Russian authorities and warned that Russian health policies and inaction could result in the emergence of “super-resistant” strains of MDR-TB.
The report is available on-line here.
Further information on this website
Russian health policies and inaction risk 'super-resistant' TB, warns MSF - news story
Tuberculosis, public health and the need for ARVs - news story
ATU, January 2003 - includes an article on the interaction between TB and HIV worldwide