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. 2007 Sep;18(5):289-91.
doi: 10.1155/2007/986794.

The emergence of extensively drug-resistant tuberculosis (TB): TB/HIV coinfection, multidrug-resistant TB and the resulting public health threat from extensively drug-resistant TB, globally and in Canada

Paul E Alexander  1 , Prithwish De
Affiliations

The emergence of extensively drug-resistant tuberculosis (TB): TB/HIV coinfection, multidrug-resistant TB and the resulting public health threat from extensively drug-resistant TB, globally and in Canada

Paul E Alexander et al. Can J Infect Dis Med Microbiol. 2007 Sep.

Abstract
in English, French

Resistance to anti-tuberculosis (TB) drugs continues to present a major challenge to global public health. Resistance usually develops due to inadequate TB management, including improper use of medications, improper treatment regimens and failure to complete the treatment course. This may be due to an erratic supply or a lack of access to treatment, as well as to patient noncompliance. However, the emergence and transmission of drug-resistant TB, including the recently detected extensively drug resistant TB (XDR-TB), is driven, in part, by the synergistic relationship between TB and HIV (TB/HIV coinfection). There is evidence that persons infected with HIV are more likely to experience XDR-TB. XDR-TB is virtually untreatable with available TB medications. XDR-TB presents a grave global public health threat, particularly in high HIV prevalence settings. The present commentary discusses the current status of XDR-TB and draws attention to the urgency in addressing this problem, for both the global and Canadian public health networks. XDR-TB and the apparent XDR-TB and HIV association warrants further study.

La résistance aux médicaments contre la tuberculose (TB) continue de poser un grave problème pour la santé publique mondiale. D’ordinaire, la résistance se manifeste en raison d’une prise en charge inadéquate de la TB, y compris un usage incorrect des médicaments, une posologie incorrecte et le fait de ne pas terminer le traitement. Ce phénomène peut s’expliquer par un approvisionnement erratique ou par le manque d’accès au traitement, de même que par la non-adhésion au traitement par le patient. Cependant, l’émergence et la transmission de la TB résistante aux médicaments, y compris la TB ultrarésistante aux médicaments (TB-URM), récemment découverte, sont partiellement imputables à la relation synergique entre la TB et le VIH (la coinfection par la TB et le VIH). Selon des données probantes, les personnes infectées par le VIH risquent davantage de souffrir de TB-URM. La TB-URM est pratiquement impossible à traiter à l’aide des médicaments disponibles. Elle pose une grave menace pour la santé publique sur la scène mondiale, notamment dans les milieux où la prévalence de VIH est élevée. Le présent commentaire traite du statut actuel de la TB-URM et souligne l’urgence de se pencher sur la question, pour les réseaux de santé publique autant mondiaux que canadiens.

Keywords: Coinfection; Drug resistance; HIV; MDR-TB; TB; Tuberculosis; XDR-TB.

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