July 1, 2010
Early detection and treatment of TB among HIV-positive individuals could avert a significant number of deaths in South Africa, suggests a new report.
Of 240 people ages 20-45 who died at a KwaZulu-Natal hospital in a recent 10-month period, 94 percent were HIV-positive and half were being treated for TB when they died, reported a team led by Harvard Medical School assistant professor Ted Cohen. That 58 percent of those being treated for TB had active infections at the time of death suggests the disease was detected too late for effective treatment.
"Most of them were getting the right drugs, [so] if they had been diagnosed earlier their lives would not have been lost. This is a major tragedy," Cohen said.
The researchers found that of the 50 percent not receiving TB treatment, 42 percent were culture-positive. Multidrug-resistant TB was detected in 17 percent of those with the disease, and the researchers suggested this more virulent form of the disease may be widespread among those with HIV.
Detection of TB in those with HIV is difficult, as sputum samples often generate a false negative. The explanation may be that the sample contains too little of the bacteria to be detected or that the disease has progressed outside the lungs.
Under South African policy, anyone with HIV should be tested for TB, and vice versa. In practice, this guidance often is ignored, said AIDS activist Paula Akugizibwe, "because of lack of infrastructure and resources."
The full report, "The Prevalence and Drug Sensitivity of Tuberculosis Among Patients Dying in Hospital in KwaZulu-Natal, South Africa: A Postmortem Study," was published in PLoS Medicine (2010;7(6):e1000296).