Important note: Information in this article was accurate in 2007. The state of the art may have changed since the publication date.
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Voice of America - November 1, 2007
Jessica Berman
Washington
A coalition of international public health officials says drug-resistant tuberculosis is a man-made epidemic caused by a lack of global response to TB. The officials say more resources are needed to fight what is an otherwise curable disease. VOA's Jessica Berman reports.
The World Health Organization estimates that 1.6 million people die each year of tuberculosis.
The reason there are so many deaths, according to the former U.N. Special Envoy for HIV/AIDS in Africa Stephen Lewis, is the failure of public health officials to promptly identify and properly treat people who are infected with TB, a situation that has led to multi-drug resistant forms of tuberculosis.
The bacterium that causes TB becomes resistant to antibiotics when patients fail to complete the entire course of antibiotics, which involves a complicated regimen of antibiotics lasting up to six months.
Individuals who are infected with AIDS are particularly vulnerable to TB because of their weakened immune systems. Stephen Lewis says up to 80 percent of people with TB also have AIDS. Data compiled by the World Health Organization show that the largest number of deaths from tuberculosis are in Africa, where AIDS is rampant.
The global community has committed resources to treat 1.6 million people with tuberculosis by 2015. But Lewis notes there are 420,000 new cases of multi-drug resistant tuberculosis each year.
And, he says, only two percent of these people are receiving adequate treatment.
"You begin to verge in the area of crimes against humanity you know, you begin to wonder when governments are inert and when the international community is in such obvious default, whether there doesn't come a point where these are almost criminal matters, where people are dying in such numbers that you can absolutely stop it and fail to do so," Lewis said.
Drug-resistant tuberculosis comes in two forms. Multi-drug resistant tuberculosis, or MDR-TB, occurs when the tuberculosis infection is resistant to one or both of the front-line anti-TB drugs, isoniazid and rifampicin.
The other form is called extensively drug-resistant tuberculosis, or XDR-TB, in which the TB bacterium does not respond to any of the older antibiotics and is resistant to at least one of the newer drugs.
Treatment for drug-resistant tuberculosis involves more radical treatment. Those with drug-resistant TB who fail to get the treatment can easily spread the disease to others.
Paul Farmer is founder of the group Partners in Health. Farmer says it is a misconception that MDR- or XDR-TB cannot be conquered.
"The goal in treatment is to have multiple drugs, at least three or four, and sometimes even surgery," he said. "So, if you have an area of the lung that is affected, and other parts of the lung that are unaffected, if you have surgical capacity removing that part of the lung can increase cure rates."
If various combinations of old and new antibiotics fail, Farmer says surgery can cure drug-resistant tuberculosis in about 50 percent of patients.
Nesri Padayatchi of South Africa's Center for the AIDS Program of Research says it is difficult to get financing for TB tests, clinics, personnel and treatments when no one is paying attention.
"I think everyone is really bored with TB," Padayatchi said. "TB is a very, very, very old disease. And it's really only become very sexy and fashionable because of HIV. And in fact, there should be a lot more attention paid to TB because HIV is strictly a behavioral issue and TB is about breathing really. It affects everybody."
The comments on TB come ahead of an international conference on tuberculosis next week in South Africa.
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