HIV complicates Africa's tuberculosis problem

Sarah McGregor:

Highly drug resistant tuberculosis could become a major killer in AIDS-hit parts of Africa where governments have been slow to roll out TB control programs, the World Health Organization said on Tuesday.

Urgent efforts are under way to revise global health plans and redirect donor funds to fight virulent strains of TB, known as extremely drug resistant or XDR-TB, after an outbreak in South Africa that has killed at least 74 people since January 2005.

Most of those cases were HIV-positive people whose immune systems were already weakened by the AIDS virus.

"The XDR-TB crisis will not in most parts of the world be solved unless HIV is properly considered. We have for now been paying lip service," Teguest Guerma, of the HIV department of WHO, told health counterparts at a TB workshop in Johannesburg.

"Underlying HIV will add significant challenges to the clinical response."

Tuberculosis is the leading killer of AIDS patients -- two diseases that are on the upswing in southern Africa.

The main concern of heath experts is the disease could have a disastrous impact in sub-Saharan Africa -- the hardest hit region in the global AIDS epidemic -- which already suffers from poor health infrastructure.

The best way to fight the dual problems of HIV/AIDS and TB is to overlap strategies to combat them, said experts.

Another big hurdle is that no new medical antibiotics for TB have been developed in four decades, and it will be until at least 2020 for new treatments to be widely available.

In South Africa, extra medications to treat TB used elsewhere promised by the government have yet to reach patients.

The price tag to ramp up international efforts is still being calculated but it could be difficult to attract new funds as the $4.7 billion required by the Global Plan to Stop TB each year consistently falls short, said officials.

However, representatives from the Global Fund to Fight AIDS, Tuberculosis and Malaria have agreed to shift existing funds to combat XDR-TB and the U.S.-backed PEPFAR is considering a similar request, said Paul Nunn of the WHO.

Government representatives from Swaziland, Lesotho, Namibia, Malawi, Zimbabwe, Mauritius, and Mozambique, WHO officials and scientists were invited to attend the two-day workshop by South African Health Minister Manto Tshabalala-Msimang.

The minister was unable to attend because she is in hospital being treated for what is being described as a lung disease.

Tshabalala-Msimang has come under harsh criticism by activists for her AIDS policies, which critics says emphasize traditional therapies over science-based solutions.

Her department has also been accused of mishandling the response the TB outbreak by failing to rollout of a national surveillance program to get a handle on the problem.

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