Once thought to be incurable, extensively drug-resistant tuberculosis (XDR-TB) can be treated in some patients, if they are not co-infected with HIV and have access to comprehensive care, according to a study published in the August 7 issue of the New England Journal of Medicine (NEJM). More than 60 percent of HIV-negative XDR -TB patients in the study, which was conducted in home and community-based settings in Peru between 1999 and 2002, were successfully treated using a combination of free, individualized drug treatment and additional services, such as surgery, adverse-event management, and nutritional and psychological support.
"It's essential that the world know that XDR-TB is not a death sentence," says lead author Carole Mitnick, a Harvard Medical School instructor in global health and social medicine. The results from Peru, which were even better than some XDR-treatment results in hospitals in Europe, the United States, and Korea, demonstrate that even in settings where there are limited resources, XDR-TB can be cured in many cases on an outpatient basis.
Writing in the same issue of NEJM, Mario C. Raviglione, head of the Stop TB Department of the World Health Organization, praised the study for changing the perception that XDR-TB is untreatable. He cautioned, however, that the high rate of successful treatment in Peru may not be reproducible elsewhere; a strain of XDR-TB reported in Italy, for example, is resistant to all available drugs. And the local capacity for TB treatment in Peru may be exceptional, because it results from cooperation among HMS, the Harvard School of Public Health, Brigham and Women's Hospital, the Massachusetts State Laboratory Institute, and the Lima, Peru-based organizations Socios en Salud, the Hospital Nacional Sergio Bernales, and the Peruvian Ministry of Health.
The question and the challenge now, writes Raviglione, is whether this model of treatment can be scaled up—not just nationally in Peru, but globally.
For more about the global threat of tuberculosis, see "A Plague Reborn."
