title: Recent tuberculosis advances in Latin America.
abstract: OBJECTIVE
  Tuberculosis kills more people than any other infection. Despite advances in diagnostic methods and greater understanding of the reasons for treatment failure, tuberculosis remains common throughout Latin America.
  
  
  RESULTS
  The impact of HIV and multidrug resistance on tuberculosis control has been enormous. HIV-positive patients may be at 10 times greater risk of multidrug resistant tuberculosis than HIV-negative patients. Hopefully, improved diagnostic techniques will allow more rapid diagnosis of tuberculosis and new colorimetric systems are being developed that will enable expedited drug-sensitivity testing. However, in alarming reports, only 58% of patients were treated with the recommended treatment regime in a Brazilian study, and dropout from treatment in parts of Bolivia was common. Many failings could be combated by rigorous education of patients and physicians. In an encouraging advance, multidrug resistant tuberculosis was successfully treated in a community-based programme, saving an estimated 90% of the cost of hospital-based treatment. An opportunity to identify treatment failure earlier is demonstrated by the finding that 2 months after the initiation of therapy, positive smears were found in only 3% of those whose treatment was successful, but 74% of those whose treatment failed.
  
  
  CONCLUSIONS
  The importance of inexpensive and widely available drugs to treat HIV and multidrug resistant tuberculosis in Latin America is clear. The need for rapid, affordable tests for tuberculosis diagnosis, and for easy drug sensitivity testing is also evident. Finally, improving treatment success is achievable even in the resource poor setting.
authors.affiliation: A. B. PRISMA, Lima, Peru.
authors.forename: Tom
authors.initials: T
authors.lastname: Pelly
authors.forename: David A J
authors.initials: DA
authors.lastname: Moore
authors.forename: Robert
authors.initials: R
authors.lastname: Gilman
authors.forename: Carlton
authors.initials: C
authors.lastname: Evans
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D000995:Antitubercular Agents / Q000627:therapeutic use; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007843:Latin America / Q000453:epidemiology; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents