Drug-resistant TB infecting HIV+ in India

Drug-resistant TB infecting HIV+ in India
26 Dec 2007, 0108 hrs IST , Kounteya Sinha , TNN

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

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

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
Paul 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."



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