Yale University

Multidrug-resistant and extensively drug-resistant tuberculosis: implications for the HIV epidemic and antiretroviral therapy rollout in South Africa.

TitleMultidrug-resistant and extensively drug-resistant tuberculosis: implications for the HIV epidemic and antiretroviral therapy rollout in South Africa.
Publication TypeJournal Article
Year of Publication2007
AuthorsAndrews, Jason R., Sarita N. Shah, Neel Gandhi, Tony Moll, and Gerald Friedland
Corporate AuthorsTugela Ferry Care and Research(TF CARES) Collaboration
JournalThe Journal of infectious diseases
Volume196 Suppl 3
PaginationS482-90
Date Published2007 Dec 1
ISSN0022-1899
KeywordsAIDS-Related Opportunistic Infections, Antiretroviral Therapy, Highly Active, Extensively Drug-Resistant Tuberculosis, HIV Infections, Humans, South Africa, Tuberculosis, Multidrug-Resistant
AbstractDrug-resistant tuberculosis (TB) is emerging as a major clinical and public health challenge in areas of sub-Saharan Africa where there is a high prevalence of human immunodeficiency virus (HIV) infection. TB drug-resistance surveillance in this region has been limited by laboratory capacity and the public health infrastructure; however, with the maturation of the HIV epidemic, the burden of drug-resistant TB is increasing rapidly. The recent discovery of large numbers of cases of multidrug-resistant (MDR) TB and extensively drug-resistant (XDR) TB in South Africa likely represents an unrecognized and evolving epidemic rather than sporadic, localized outbreaks. The combination of a large population of HIV-infected susceptible hosts with poor TB treatment success rates, a lack of airborne infection control, limited drug-resistance testing, and an overburdened MDR-TB treatment program provides ideal conditions for an MDR-TB and XDR-TB epidemic of unparalleled magnitude. In the present article, we review the history of drug-resistant TB in South Africa, describe its interaction with the HIV epidemic and the resultant consequences, and suggest measures necessary for controlling MDR-TB and XDR-TB in this context. A successful response to the emergence of MDR-TB and XDR-TB will necessitate increased resources for and collaboration between TB and HIV programs.
DOI10.3109/00952990.2011.568081
Alternate JournalJ. Infect. Dis.

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