Extensively Drug-Resistant Tuberculosis as a Cause of Death in Patients Co-Infected With Tuberculosis and HIV in a Rural Area of South Africa

The authors of the current study noted the close association between HIV-1 and TB in South Africa. In the sub-Saharan Africa, TB is the most common cause of morbidity and mortality for people infected with HIV-1. In South Africa, while antiretroviral therapy has helped to decrease AIDS mortality among patients who are TB-co-infected, drug-resistant TB has surfaced as a major cause of death. In this context, researchers assessed the prevalence and consequences of multidrug-resistant (MDR) and extensively drug-resistant TB (XDR-TB)in the Msinga sub-district of KwaZulu Natal, South Africa.

The investigators conducted enhanced surveillance for drug-resistant TB with sputum culture and drug susceptibility testing in patients with known or suspected TB. Isolates resistant to first- and second-line drugs were genotyped.

Sputum was obtained from 1,539 patients between January 2005 and March 2006. MDR-TB was detected in 221 patients, among whom 53 had XDR-TB. Among 475 culture-confirmed TB patients, MDR-TB prevalence was 39 percent (185 patients) and 6 percent (30) for XDR-TB. Fifty-five percent of XDR-TB patients had not been previously treated for TB (26 of 47 patients); but 67 percent had a recent hospital admission (28 of 42 patients). All 44 patients with XDR-TB who were tested for HIV were co-infected. Fifty-two of 53 XDR-TB patients died, with an average survival of 16 days after diagnosis among the 42 patients with confirmed dates of death. Genotyping of isolates showed 39 of 46 XDR-TB patients had similar strains (85 percent; 95 percent confidence interval, 74-95).

"MDR tuberculosis is more prevalent than previously realised in this setting," researchers concluded. "XDR tuberculosis has been transmitted to HIV co-infected patients and is associated with high mortality. These observations warrant urgent intervention and threaten the success of treatment programmes for tuberculosis and HIV."

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