HIV causing tuberculosis epidemic in South Africa

Tuberculosis and HIV are together taking a huge toll on South Africa, say researchers.

Tuberculosis is the top official cause of death in South Africa, but accurate diagnosis is difficult. People with HIV are particularly susceptible because of their weakened immune system, and there has been a dramatic rise in the rate of tuberculosis alongside HIV infection.

Dr Ted Cohen and colleagues at Brigham and Women’s Hospital, Boston, USA, carried out autopsies on 240 young adults who died in a public hospital in the province of KwaZulu-Natal.

Patients were aged 20 to 45 years at the time of death, between October 2008 and August 2009. Tuberculosis was diagnosed via samples from the respiratory tract and biopsies from the lung, liver, and spleen.

A very large proportion – 94 per cent – of the patients were HIV positive. Half tested positive for tuberculosis.

Fifty per cent were taking tuberculosis treatment at the time of death. Among patients with tuberculosis, 17 per cent were multidrug resistant.

The study is published in the open access medical journal PLoS Medicine. The authors write: "Our findings reveal the immense toll of tuberculosis among HIV-positive individuals in KwaZulu-Natal.

"The majority of decedents who remained culture-positive despite receiving tuberculosis treatment were infected with pansusceptible M. tuberculosis, suggesting that the diagnosis of tuberculosis was made too late to alter the fatal course of the infection.

"There is also a significant burden of undetected multidrug-resistant tuberculosis among HIV-coinfected individuals dying in this setting."

They say there is an urgent need for new public health approaches to improve early diagnosis of tuberculosis and speed the initiation of treatment.

Cohen, T. et al. The Prevalence and Drug Sensitivity of Tuberculosis among Patients Dying in Hospital in KwaZulu-Natal, South Africa: A Postmortem Study. PLoS Medicine, 7 (6): e1000296.