Washington Post Examines Global Spread of XDR-TB

The Washington Post on Thursday examined how extensively drug-resistant tuberculosis -- TB that is resistant to the two most potent first-line treatments and some of the available second-line drugs -- is "raising fears" of a pandemic that could "devastate" efforts to control TB and "prove deadly" to people with HIV/AIDS and other diseases. According to the Post, XDR-TB has been detected in 37 countries. Some health experts say that at least half the people who contract XDR-TB will die of the disease. According to the Post, Russia has become a "petri dish" for TB drug resistance. About 22,000 people in the country have some form of drug-resistant TB, and an unknown number of those have XDR-TB, the Post reports. At least 30% of people receiving treatment for TB in the country do not complete their drug regimens, which increases the chance of developing resistance. Russia also has about one million people living with HIV/AIDS, which further exacerbates the TB situation, the Post reports.

HIV/TB coinfection also has helped fuel the "major TB infection zone" in South Africa, the Post reports. According to a Yale University study, 52 out of 53 people diagnosed with XDR-TB in a rural hospital in the country died. Most of those who died, including six health care workers, also were HIV-positive and died an average of 16 days after diagnosis. In addition, a study published last year in CDC's Morbidity and Mortality Weekly Report that was based on a survey of TB labs on six continents found that the prevalence of XDR-TB increased from 3% of TB cases to 11% of cases between 2000 and 2004.

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According to Mario Raviglione, head of the World Health Organization's Stop TB Department, XDR-TB likely will mutate into a completely drug-resistant form of TB if it is not contained. "We will be left with surgery and prayers," he said, adding, "It's a desperate situation." Doctors and medical ethicists also are attempting to address the situation of people with XDR-TB who are not cooperative with treatment. Some have said that countries will have to consider forcing these people into isolation. "We have to face the possibility that restrictive measures may be necessary to control what could become a global pandemic," Ross Upshur, director of the University of Toronto's Joint Center for Bioethics, said. He added that although he is not advocating detention as a first response, "if voluntary measures fail, people do not have the right to infect others." Other experts have said forced isolation is impractical in poor countries and might drive the disease underground (Finn, Washington Post, 5/3).

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