Drug-resistant TB infecting HIV+ in India

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Drug-resistant TB infecting HIV+ in India

26 Dec 2007, 0108 hrs IST , Kounteya Sinha , TNN

NEW DELHI: Extensively drug-resistant tuberculosis (XDR-TB), the

untreatable form, has now started to infect India's HIV patients. A

study conducted by AIIMS's clinical microbiology department has

revealed shocking results — over 33% of those enrolled for the study,

with both HIV and TB, were found to be suffering from XDR-TB. What's

worse, all the patients with XDR-TB died within three months of

diagnosis.

The study conducted by a three member team, headed by Dr Sarman

Singh, head of the department of lab medicine, has been reported in

the November issue of the international journal 'AIDS'.

Dr Singh told TOI, " Fifty-four AIDS patients suspected of having HIV-

tuberculosis co-infection were investigated in 2006 for the

prevalence of XDR-TB. Out of them, TB was isolated from 24 (44.4%).

Twelve (50%) of these had resistance to first-line drugs, whereas

four (33.33%) were also resistant to second-line drugs. " He

added, " This is the largest study done in India with subjects being

coinfected with HIV and TB. After isolating the TB culture, we tried

for antibiotic sensitivity. This is the first time that XDR-TB has

been found to infect HIV patients in India. "

According to Dr Singh, XDR-TB is a grave public health

threat. " Officials of India's TB Control Programme must stop denying

that XDR-TB exists in India, " he said.

The study comes months after researchers from Hinduja National

Hospital in Mumbai first found XDR-TB in 8% of all TB patients. The

team had examined 3,904 lab samples and found 1,274 were positive for

TB. Of these, 32% were multiple drug resistance (MDR-TB), of which 8%

were XDR-TB cases. Mortality rate of XDR-TB patients in the study was

as high as 42%. XDR-TB cases are those MDR-TB sufferers who are

resistant to all known TB medicines. This occurs when a physician

does not prescribe a proper treatment regimen or when a patient, who

is already suffering from MDR-TB, does not complete his lengthy

therapy.

However, India's National TB Control Programme has no data on the

prevalence of XDR-TB. India, in fact, has just woken up to MDR-TB and

doctors have started diagnosing and treating it in two labs in

Gujarat and Maharashtra. After detecting MDR-TB, 50 people have been

put on DOTS Plus treatment. Dr Saumya Swaminathan from TRC Chennai

told TOI, " We have received 1,200 TB samples from the lab in Gujarat

of which 200 are MDR-TB. We are finding out how many of these are XDR

to get an idea of its overall prevalence. "

Dr Swaminathan, however, said the AIIMS and Hinduja figures could not

be extrapolated. " Both are tertiary referral hospitals getting the

worst patients. Also, the AIIMS sample size is too small. The study

being done in TRC Chennai, results of which will be out in February,

will give a better idea of XDR-TB's prevalence in the country. "

TB is the single largest killer of AIDS patients in India. Naco

reveals that over 60% of all AIDS patients contract and ultimately

die of TB. WHO's coordinator for TB/HIV and drug resistance programme

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 defences immediately. If this XDR-TB strain mixes with HIV, the

combination is explosive as it causes 100% mortality. "

kounteya.sinha@...

http://timesofindia.indiatimes.com/India/Drug-

resistant_TB_infecting_HIV_in_India/articleshow/2650882.cms