Monday 1 February 2010

TB or not TB.

The SA government has this week announced (or in fact reiterated) policy that all HIV patients starting anti-retrovirals without signs of active TB should be treated prophylactically with Isoniazid (a TB drug).The reasoning is that this treats latent TB, which can flare up in patients as their immune system improves, with dire consequences. However, TB is absolutely rife here; along with (and not unconnected from) HIV it is the thing we see most of. And with limited resources (and even with good resources) it can be difficult to diagnose and we're almost certainly undertreating it. If we give all these patients Isoniazid when they actually have undiagnosed active TB, we will fairly certainly soon have widespread resistance.
We're already facing patients who for a number of reasons are unwilling or unable to take the medicines and so we are seeing increasing numbers of MDR (multi-drug resistant) and XDR (extremely drug resistant) versions.
In an ideal setting these patients would be isolated until no longer infective but as we have no MDR ward, we are faced with the difficult decison of whether to keep them in hospital, spreading and mutating it with other TB patients, or to let them go home, putting their family and community at risk and creating more MDR TB cases.
It's all rather scary. If the current situation continues, South Africa will shortly produce a version of TB which is resistant to all treatment. And as disease doesn't recognise borders, that will be a problem for the whole world.

Ironically the SA goverment required me to prove that I didn't have TB before they granted my visa to work here.

No comments:

Post a Comment