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Global consequences for HIV and drug resistant tuberculosis in Africa

Society For General Microbiology : 05 June, 2007  (Technical Article)
Africa has 10% of the worldwide population but is also home 70% of the world
In South Africa, an outbreak of a highly drug resistant strain of tuberculosis is killing almost everyone with HIV who catches it, according to the Federation of Infection Societies.

In southern Africa, which has the highest rate of HIV, the majority of new tuberculosis cases are found in patients who also have HIV infections. Because of the brain drain of African healthcare professionals who are being lured to work in other countries, including the UK, the medical facilities are finding it difficult to cope with this public health catastrophe.

“Until recently we could not find any link between HIV and multi-drug resistant tuberculosis in Africa. But a new South African outbreak of extremely drug-resistant disease, which kills almost everyone who catches it, has highlighted the risks of transmission and the rapid way the disease progresses in HIV infected individuals”, says Professor Gary Maartens from the University of Cape Town, South Africa.

The two epidemics are both contributing to each other, with tuberculosis also accelerating AIDS development in HIV positive patients.

“The cornerstone of tuberculosis diagnosis is by looking at a smear of spit under a microscope after staining it. This is cheap and in most areas the only available test”, says Prof Maartens. “Unfortunately this test often shows up negative if the patient is also infected with HIV. However we should be able to use our normal drugs to treat tuberculosis effectively, even when the patient has an HIV infection. Unfortunately the different drugs used for tuberculosis and HIV interact with each other, making co-treatment complex”.

Experts fear that unless the infrastructure improves in southern Africa, and developed countries stop poaching the best and most experienced doctors and nurses, the tuberculosis epidemic will continue to grow. This will have world wide consequences, since it is the HIV epidemic in sub-Saharan Africa which is driving the current global return of tuberculosis, including the increasing number of cases seen in the UK and other western European nations.

“No single strategy will turn around the African tuberculosis epidemic, but a combined group of interventions will be effective”, says Professor Maartens. “We need to develop strategies to retain our healthcare professionals, and we need some resources”.
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