Drug Resistant TB Declines but Still a Threat

Ivanhoe Newswire

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(Ivanhoe Newswire) -- The number of extensively drug-resistant tuberculosis (XDR-TB) cases in the United States has declined in the past 15 years, but new cases of the deadly disease are still being reported. The drop may be related to improved TB and HIV/AIDS control, researchers say.

Tuberculosis is the leading cause of infectious deaths of adults worldwide. Recently, drug-resistant strains of the disease have increased that threat, contributing to 289,000 new cases in 2006. Treating multidrug-resistant TB (MDR-TB) is more than 100 times more expensive than standard TB treatment and requires more intensive care.

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In 2005, a new category of TB was defined -- XDR-TB -- because of its even greater resistance to drugs.The resistance was especially prevalent in areas throughout the world with a large amount of individuals infected with HIV.

Researchers say from 1993 to 2007, 83 cases of XDR-TB were reported across the country. The number of cases dropped from 18 in 1993 to two in 2007. In the first four years of that time frame, 62 percent of XDR-TB cases involved an HIV-infected person; however, from 1998 to 2007, only 14 percent of the cases occurred in such individuals.

Death rates of XDR-TB were also found to be nearly two times greater than among MDR-TB cases and more than six-times greater than among drug-susceptible TB cases. In addition, those with the severe form of TB were more likely to be Hispanic compared with those with the drug-susceptible form.

Preventing the further emergence of drug resistance is paramount and must include not only TB program strengthening to ensure that patients complete their treatment regimen, but also general health system interventions to improve infection control, study authors concluded.

SOURCE: JAMA, 2008;300[18]:2153-2160

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