Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis: Implications for the HIV Epidemic and Antiretroviral Therapy Rollout in South Africa

• Published in: The Journal of infectious diseases 2007-12, Vol.196 (Supplement-3), p.S482-S490
• Main Authors: Andrews, Jason R, Sarita Shah, N, Gandhi, Neel, Moll, Tony, Friedland, Gerald
• Format: Article
• Language: English
• Subjects: AIDS; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - epidemiology; AIDS-Related Opportunistic Infections - microbiology; AIDS-Related Opportunistic Infections - virology; Antiretroviral Therapy, Highly Active - methods; Antiretrovirals; Bacterial diseases; Biological and medical sciences; Drug resistance; Epidemics; Extensively Drug-Resistant Tuberculosis - drug therapy; Extensively Drug-Resistant Tuberculosis - epidemiology; Extensively Drug-Resistant Tuberculosis - microbiology; Extensively Drug-Resistant Tuberculosis - virology; Fundamental and applied biological sciences. Psychology; HIV; HIV infections; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - microbiology; HIV Infections - virology; Human bacterial diseases; Human immunodeficiency virus; Humans; Infectious diseases; Medical sciences; Microbiology; Miscellaneous; Multidrug resistant tuberculosis; Mycobacterium; Mycobacterium tuberculosis; Pulmonary tuberculosis; South Africa - epidemiology; Tuberculosis; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Multidrug-Resistant - drug therapy; Tuberculosis, Multidrug-Resistant - epidemiology; Tuberculosis, Multidrug-Resistant - microbiology; Tuberculosis, Multidrug-Resistant - virology; Virology
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/521121

Drug-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.