title: Review of multidrug-resistant and extensively drug-resistant TB: global perspectives with a focus on sub-Saharan Africa.
abstract: Tuberculosis (TB) remains a global emergency and is responsible for 1.7 million deaths annually. Widespread global misuse of isoniazid and rifampicin over three decades has resulted in emergence of the ominous spread of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) globally. These difficult to treat resistant forms of TB are increasingly seen in Asia, Eastern Europe, South America and sub-Saharan Africa, disrupting TB and HIV control programmes. We review the latest available global epidemiological and clinical evidence on drug-resistant TB in HIV-infected and uninfected populations, with focus on Africa where data are scanty because of poor diagnostic and reporting facilities. The difficult management and infection control problems posed by drug-resistant TB in HIV-infected patients are discussed. Given the increasing current global trends in MDR-TB, aggressive preventive and management strategies are urgently required to avoid disruption of global TB control efforts. The data suggest that existing interventions, public health systems and TB and HIV programmes must be strengthened significantly. Political and funder commitment is essential to curb the spread of drug-resistant TB.
authors.affiliation: WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Tradate, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Migliori
authors.forename: Keertan
authors.initials: K
authors.lastname: Dheda
authors.forename: Rosella
authors.initials: R
authors.lastname: Centis
authors.forename: Peter
authors.initials: P
authors.lastname: Mwaba
authors.forename: Matthew
authors.initials: M
authors.lastname: Bates
authors.forename: Justin
authors.initials: J
authors.lastname: O'Grady
authors.forename: Michael
authors.initials: M
authors.lastname: Hoelscher
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001208:Asia / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use*; D012293:Rifampin / Q000627:therapeutic use*; D013020:South America / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin