Feature Story

According to the 4th World Health Organization (WHO) report on anti-tuberculosis drug resistance released on 26 February, multi-drug resistant tuberculosis* (MDR TB) has been shown to be almost twice as common in tuberculosis (TB) patients living with HIV compared to TB patients without HIV.

The report presents the findings of the largest survey of TB drug resistance to date with information collected between 2002 and 2006 from 90,000 TB patients in 81 countries. It demonstrates the highest rates of MDR-TB ever recorded with nearly half a million new cases of MDR-TB worldwide each year––around 5% of the total 9 million new TB cases. It also found that extensively drug-resistant tuberculosis** (XDR-TB), a virtually untreatable form of the respiratory disease, has been recorded in 45 countries.

The true scale of the problem also remains unknown in some pockets of the world. Only six countries in Africa—the region with the highest incidence of TB in the world***––were able to provide drug resistance data for the report, and none of these were able to provide information on drug resistance in people living with HIV. Other countries in the region could not conduct surveys because they lack the equipment and trained personnel needed to identify drug-resistant TB.

‘This report confirms the serious threat that drug resistant TB poses to people living with HIV,’ said Alasdair Reid HIV/TB Adviser, UNAIDS. ‘UNAIDS, together with WHO and our international partners, is working with TB and HIV programmes in countries across the world to ensure they work more closely together to prevent the development and spread of drug-resistant TB among people living with HIV through better diagnosis and treatment of TB in people living with HIV and improved TB infection control in HIV care settings and communities affected by HIV’.

WHO estimates that US$ 4.8 billion is needed for overall tuberculosis control in low- and middle-income countries in 2008, with US$ 1 billion needed to respond to drug resistant tuberculosis. There is currently a gap in financing of US$ 2.5 billion, including a US$ 500 million gap for drug resistant tuberculosis.

NOTE TO EDITORS:

* The bacteria responsible for TB becomes resistant when people who are ill with TB are not provided with or do not complete a full course of medication. Drug-resistant TB, like drug-sensitive TB, can also be transmitted through the air from an infected person to a non-infected person. MDR-TB is a form of TB that does not respond to the standard six month treatment using first line-drugs (i.e. resistant to isoniazid and rifampicin). It can take two years to treat with drugs that are 100 times more expensive than first-line treatment.

** XDR-TB is a form of TB caused by bacteria resistant to virtually all the most effective anti-tuberculosis drugs (i.e. MDR-TB plus resistance to any fluoroquinolones and any one of the second-line anti-tuberculosis injectable drugs: amikacin, kanamycin or capreomycin).

*** In sub-Saharan Africa HIV is dramatically fuelling the spread of TB which is a major cause of death among people living with HIV. MDR-TB and XDR-TB are highly lethal in people living with HIV––studies show case fatality rates of over 90%. Drug-resistant TB is therefore a major threat to the effectiveness of both TB treatment and anti-retroviral treatment programs.