Untreatable’ TB strain causes alarm

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‘Untreatable’ TB strain causes alarm

September 7, 2006 Times of India Kounteya Sinha | TNN

New Delhi: It’s a grave public health threat that’s taking alarming proportions.

A virtually untreatable form of tuberculosis — extreme drug resistant TB (XDRTB)

— is spreading all over the world, including India.

A survey conducted by WHO and the US Center for Disease Control on data from

2000-2004 found that XDR-TB is most frequent in countries of the former Soviet

Union and Asia.

There is, however, further bad news — the XDR-TB strain is mixing with the AIDS

virus causing nearly 100% mortality. WHO’s coordinator for TB/HIV and drug

resistance programme Nunn calls it ‘‘an explosive combination’’. With the

threat extremely serious, Nunn is holding an urgent meeting in Johannesburg on

Thursday and Friday to address the management of this deadly strain of TB. South

Africa is worst affected by the strain.

Nunn told TOI that 52 of the 53 patients with XDR-TB in South Africa died within

210 days, between January 2005 and March 2006. The deaths occurred on an average

within 25 days even in those HIV patients who were taking antiretroviral drugs.

Even in the US, which has the best medicines available, a third of those who

were diagnosed with XDR-TB have died.

Nunn said, ‘‘XDR-TB problem is relatively small in India right now. But the

worrying thing is that it is there. India must prepare its defenses immediately.

Like SA, India has a severe burden of HIV patients. If this XDR-TB strain mixes

with HIV, the combination is explosive.

India must immediately undertake a survey to gauge the extent of XDR-TB

presence, specially in an HIV burden area like Mumbai.’’

Nunn has several other suggestions for India: increase the number of labs to

diagnose TB cases, improve management of clinical cases, strengthen basic TB

care to prevent the emergence of drug-resistance and increase collaboration

between HIV and TB control programmes to provide necessary prevention and care

to co-infected patients.

According to India’s health ministry records, over 3% of the fresh cases are

suffering from XDR-TB while over 12% of old cases undergoing treatment have

developed this strain.

This new strain is not only resistant to the two first-line therapies —

antibiotics Isoniazid and Rifampin but also to the six classes of drugs used for

second-tier therapy.

TB has also become the single largest killer of AIDS patients in India.

National Aids Control Organisation recently revealed that over 60% of all AIDS

patients contract and ultimately die of TB. NACO has now decided to scale up and

integrate the National AIDS and TB control programmes from 2006.

Director-general of the TB control programme L S Chauhan said that every year,

1.8 million new cases occur in the country of which 0.8 million are infectious.

‘‘Unless treated properly, each infectious pulmonary TB patient can infect 10 to

15 persons a year. TB patients not properly treated can develop potentially

incurable forms of the disease. Since no new drugs have been discovered since

1968, the germs have now started to develop drug resistance.’’

Nunn said work was underway looking at new drugs, including research into TB

vaccines.

http://timesofindia.indiatimes.com/articleshow/1964382.cms