The Rise of Totally Drug-Resistant TB

January 17, 2012
by Mandy Slutsker

This blog entry was originally contributed to by Mandy Slutsker

Andrew Speaker caused an international incident in 2007 when he boarded an international flight while infected with XDR-TB, a form of tuberculosis resistant to most available drugs. It was terrifying to imagine what could have happened if the flight had taken off. Was there anything scarier than flying next to a person with extensively resistant TB?

Apparently, there is.

This week doctors in India identified twelve cases of TB that are totally drug resistant (TDR-TB). Whereas XDR-TB is sixty percent fatal, this new form of TB is one hundred percent fatal. Researchers, policymakers, and patients are scrambling to make sense of it all. Although India’s TB program has been successful, it fails to include patients with multi-drug resistant TB. Ninety-nine percent of Indians lack access to proper treatment for drug-resistance, which has fueled the rise in XDR and given root to this new form of totally resistant TB.

This new strain threatens to take us back sixty years ago when TB was incurable. But things have changed in the last sixty years. Now there’s HIV.

It’s terrifying to imagine the impact this new form of totally drug resistant TB could have if it combines with HIV. Sub-Saharan Africa has the highest rate of TB-HIV co-infection in the world. In some places like Swaziland, over eighty percent of people diagnosed with TB are also infected with HIV. Drug-resistant TB is particularly dangerous in this population because it preys on people with weakened immune systems.

“If we had a strain [of TB] for which there is no treatment… It would be mean mass devastation” says Carol Nyirenda, Zambian TB-HIV activist and patient advocate. Zambia is currently experiencing stock outs of anti-TB drugs – shortages that develop of drug-resistance. Emergence of TDR-TB would place even more strain on the already fragile health system. Laboratory capacity is another problem. “We don’t have the capability to do that kind of testing,” Nyirenda explains.

The threat of drug-resistant TB and HIV has been around for the last decade, but little has been done to address the problem. Dr. Jim Kim, co-founder of Partners in Health warned in PBS’s documentary Rise of the Superbugs, “When drug-resistant TB and HIV collide, as it is right now in places like South Africa…it is going to be a disaster, the likes of which I think will surprise many of us. … There is no reason we shouldn’t be able to get it under control now, with resources that are pitiful compared to what we spend on so many other silly things.”

It’s time global leaders take immediate action to control and prevent the spread of TB. “We need to ensure a constant supply of anti-TB drugs and more education around TB,” explains Nyirenda. This new form of totally drug-resistant TB must be taken very seriously. It won’t be long before the new strain surfaces elsewhere. After all, TDR-TB is only a plane ride away.

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