- The Washington Times - Wednesday, November 15, 2006


Untreatable new strains of tuberculosis spreading unchecked through Africa could kill millions of people and reverse years of costly efforts to keep HIV patients alive, say doctors.

Kenya, Tanzania and Uganda are reporting increasing numbers of cases of drug-resistant versions of tuberculosis, and they fear that these are only the tip of the iceberg. If these strains take hold, even the newest and most expensive drugs will be virtually useless as patients already weakened by HIV fall prey to the new TB.

Health specialists have given warning that the lung disease, which was such a killer in the 19th century, is making a comeback in Britain with 11 percent more cases last year than in 2004. Most of the British cases are successfully treated with a six-month regime of cheap drugs developed in the 1950s, which are still largely effective against common TB.

However, poor health services in overcrowded and poorer populations who do not stick to their prescriptions, combined with soaring rates of HIV, mean that the tuberculosis bacillus is mutating in many developing countries.

Because TB is so easily spread through coughs and sneezes, those mutations could get a foothold in Britain. Doctors have already identified several cases.

Kenya has reported its first 48 cases of multidrug-resistant TB in the past nine months, most of them clustered in Nairobi’s crammed and fetid slums. Many more are expected.

In a walled compound of single-story blue buildings off a potholed road running through Mathare, a slum inhabited by 300,000 people, doctors are treating two patients for multidrug-resistant TB, widely called MDR TB. They are waiting for test results on five other patients.

“Our clinic caters to 2,500 people living here, half of whom have been tested for TB, and these few have tested positive for MDR,” said Dr. Liesbet Ohler, 31, a Belgian working with Doctors Without Borders. “But diagnosing it, especially if the patient also has HIV, is time-consuming and difficult, and we have no way of knowing how many others there are out there carrying around MDR and infecting others.”

This is the crux of the problem. Being diagnosed with TB carries a stigma in countries where the infection is so closely linked with HIV that if you have one, you are assumed to have the other.

So, many infected carriers do not seek tests, even if they could reach a health center that could carry out the procedure. Of those who do take the test and start taking the drugs, up to 10 percent fail to finish their treatment.

If a patient stops taking the medicine for just three days, resistance begins to build up against the six known antibiotics that are effective against TB.

There are an estimated 50 million cases of MDR TB globally, according to the World Health Organization, and 300,000 new patients are infected each year.

There are increasing cases of the even nastier “extensively drug-resistant TB” , which defeats all known drug combinations.

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