Multidrug-resistant and extensively drug-resistant tuberculosis: consequences for the global HIV community.
OBJECTIVE
Physicians, researchers and policy makers must understand the myriad consequences of multidrug and extensively drug-resistant tuberculosis (TB) within the HIV community in order to guide clinical care, research and resource allocation.


RESULTS
Extensively drug-resistant TB can no longer be considered as occurring in isolated outbreaks as it has been reported in 45 countries from all regions of the world. HIV has been associated as an independent risk factor for infection with drug-resistant TB. HIV patients appear more likely to suffer from primary, transmitted resistance as opposed to developing acquired resistance during the course of treatment for TB. New rapid diagnostics offer promise of providing clinically useful first-line drug susceptibility information but require validation in HIV patients and smear negative individuals. Demonstration projects of community-based treatment of drug-resistant TB and integration of TB and HIV care provide opportunities to decentralize management of drug-resistant TB.


CONCLUSIONS
Multidrug-resistant and extensively drug-resistant TB disproportionately affect HIV patients and result in increased morbidity and mortality. In this study, we address these challenging issues and offer some short-term and longer term strategies for their alleviation.
Shenoi
Sheela
S
Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA.
Heysell
Scott
S
Moll
Anthony
A
Friedland
Gerald
G
D019090:Case Management; D054908:Extensively Drug-Resistant Tuberculosis / Q000453:epidemiology* / Q000401:mortality; D015658:HIV Infections / Q000150:complications* / Q000276:immunology*; D006801:Humans; D015994:Incidence; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology / Q000401:mortality