According to the Centers for Disease Control and Prevention (CDC), nearly 50 percent of all AIDS patients will die from tuberculosis (TB) related complications, which is why the story of Peruvian immigrant Oswaldo Juarez is important for HIV and AIDS patients worldwide.

Nearly two years ago, Juarez woke up one night coughing up blood. The nineteen year old student had been sick with flu like symptoms for days; however, after coughing blood, doctors were concerned that Oswaldo Juarez was ill with extremely contagious and drug resistant tuberculosis (XXDR TB).

Tuberculosis can be found in various forms: regular (or drug susceptible TB), multidrug resistant TB (MDR TB), extensively drug resistant TB (XDR TB), and extremely drug resistant TB (XXDR TB).

XXDR TB is so rare that only a few people are thought to have had it in the world, and experts claim that Juarez was the first person to ever have this strain in the United States.

For HIV and AIDS patients, any drug resistant form of TB can pose potential problems, as HIV patients have weakened immune systems and are more at risk for contracting the disease.

MDR TB is resistant to two of the best known treatment drugs, Niazid (isoniazid) and Rifadin (rifampin), which are “first line” treatments. When a person has this strain, they are treated with “second line” antibiotic drugs. Although the prevalence of this type of TB has been decreasing in the U.S., nearly every state has reported a case of MDR TB in the past.

Between 1993 and 2004, the CDC reported that 74 cases of XDR TB had occurred in the U.S. XDR TB is not only resistant to first line treatments, but also to second line treatments. This makes it incredibly difficult to treat patients with this strain of TB.

TB is caused by the bacteria Mycobacterium tuberculosis, which spreads most commonly by airborne transmission. It can affect any part of the body, but is generally known to affect the lungs. Symptoms include severe cough, chest pains, and the coughing of blood. In addition, these symptoms may be accompanied by fatigue, chills, weight loss, weakness, fever, and night sweats (for more information on TB and HIV, see related Beacon News).

People can be infected with active or inactive TB. If a person has active TB, it means that his or her immune system was unable to successfully combat the bacteria. Thus, he or she will develop the symptoms of TB and can also transmit the disease to other people through coughing, sneezing, or spitting.

People with inactive tuberculosis, or latent TB, have successfully fought off the disease. This means that they do not develop symptoms of TB and cannot transmit it to others. However, the bacteria are still present in their bodies and can become active if their immune systems become weakened later in life. For example, this can occur if an individual contracts HIV.

In response to the developing threat of TB, the CDC has created an action plan to deal with potential problems related to the disease.

With regard to HIV and AIDS patients, the CDC hopes to improve laboratory confirmation of all forms of TB in HIV/AIDS patients through advanced testing methods and lab procedures.

The CDC also wishes to address the problem of correctly diagnosing XDR TB by educating health care professionals and by recommending HIV testing during patient evaluation for TB.

Finally, the CDC plans to increase research exploring interactions between drugs used to treat TB and drugs used amongst high risk populations, such as antiretroviral drugs used by HIV patients. The efficacy of TB drugs in such high risk groups will also be researched.

For more information, please see the CDC Web site and the Associated Press news article.