Scientists Confront Joint HIV-TB Epidemics by Taking Fight to the Front Lines

Abstract

THE EMERGENCE OF EXTENSIVELY drug-resistant tuberculosis (XDRTB) in patients at a rural hospital in theKwaZulu-NatalprovinceofSouth Africa gained international attention in 2005. By that point, physicians had becomeaccustomedtoencounteringcases of multidrug-resistant TB (MDR-TB). When first-line antibiotics failed, they knew they could turn to more toxic and lesseffectivesecond-linechoices.But the outbreakinKwaZulu-Natalledtothe“recognition that untreatable TB was out there,”explainedWilliamR.Bishai,MD, PhD, codirector of the Johns Hopkins Center for Tuberculosis Research in Baltimore. Ultimately, 52 of the 53 patients first identifiedashavingXDR-TBinKwaZuluNatal died, on average within 16 days of diagnosis(GandhiNRetal.Lancet.2006; 368[9547]:1575-1580). From January 2005toMarch2006, theresearcherswho documented these first cases examined sputum from a total of 1539 TB patients inKwaZulu-Natalandfoundthat39%of the patients had MDR-TB and 6% had XDR-TB. “It was a real wake-up call for South Africa and the world,” Bishai said. In addition to his work at Hopkins, Bishai is leading a new international research center, which opened last month in Durban, South Africa. The KwaZuluNatal Research Institute for Tuberculosis and HIV (K-RITH) is the fruit of a cooperative effort between the Howard Hughes Medical Institute (HHMI) and the University of KwaZulu-Natal to bring world-class researchers and state-of-the-art facilities to the front lines of the fight against XDR-TB and HIV coinfection. Dr Bishai discussed this new venture with JAMA. JAMA: Why was K-RITH created? Dr Bishai: The HHMI trustees and University of KwaZulu-Natal leadership decided it was time to do something different, something in global