Multidrug-resistant and extensively drug-resistant tuberculosis: consequences for the global HIV community

Abstract

Purpose of review: Physicians, researchers and policy makers must understand the myriad consequences of multidrug and extensively drug-resistant tuberculosis (TB) within the HIV community in order to guide clinical care, research and resource allocation.

Recent findings: Extensively drug-resistant TB can no longer be considered as occurring in isolated outbreaks as it has been reported in 45 countries from all regions of the world. HIV has been associated as an independent risk factor for infection with drug-resistant TB. HIV patients appear more likely to suffer from primary, transmitted resistance as opposed to developing acquired resistance during the course of treatment for TB. New rapid diagnostics offer promise of providing clinically useful first-line drug susceptibility information but require validation in HIV patients and smear negative individuals. Demonstration projects of community-based treatment of drug-resistant TB and integration of TB and HIV care provide opportunities to decentralize management of drug-resistant TB.

Summary: Multidrug-resistant and extensively drug-resistant TB disproportionately affect HIV patients and result in increased morbidity and mortality. In this study, we address these challenging issues and offer some short-term and longer term strategies for their alleviation.

Figure 1. Countries with extensively drug-resistant TB cases as of June 2008

All regions of the world are represented. The largest cluster remains in the province of KwaZulu Natal, South Africa. Note that areas of the world with the greatest TB burdens (Africa, Southeast Asia and China) are underrepresented – the result of limited laboratory infrastructure needed for XDR TB diagnosis. Refer to http://www.who.int/tb/challenges/xdr/xdr_map_june08.pdf. Reproduced from [5•] with permission from the WHO.