Division of General Internal Medicine

Transmission of Drug-Resistant TB in South Africa Study Published in New England Journal of Medicine

James Brust, MD
James Brust, M.D.


Efforts to prevent extensively drug-resistant (XDR) tuberculosis (TB) from spreading have traditionally relied on improving patient treatment. But a study co-authored by James Brust, M.D., and his former colleagues N. Sarita Shah, M.D., Ph.D. (lead author), and Neel R. Gandi, MD (senior author), and published in the January 18 online issue of The New England Journal of Medicine suggests that efforts to halt TB transmission in hospitals and community settings may be a better strategy. Drs. Shah and Gandi were associate professors of medicine (general internal medicine) at Einstein until 2012.

The study, conducted with collaborators at Emory University, the U.S. CDC, and the University of KwaZulu-Natal, enrolled 404 TB patients from South Africa’s KwaZulu-Natal province. All had XDR-TB, meaning their infections were resistant to at least four first-line and second-line TB drugs. South Africa is experiencing a widespread epidemic of XDR-TB, and many people there are co-infected with HIV, which weakens their immunity. The study found that transmission of XDR-TB was responsible for at least 69 percent of cases. By contrast, only 31 percent of cases involved patients who developed XDR-TB during treatment.

Dr. Brust is attending physician and associate professor of medicine (general internal medicine). His research has focused on the dual epidemics of multidrug-resistant tuberculosis (MDR TB) and HIV in KwaZulu-Natal (KZN), South Africa. He designed and implemented a novel, home-based treatment program for patients co-infected with HIV and MDR TB and was awarded a K23 Career Development grant from the NIAID to study the program. He was recently awarded a five-year, $3.6 million R01 from NIAID to study the new TB medication, bedaquiline in patients with extensively drug-resistant (XDR) TB--specifically to define the genetic mechanisms of resistance and drug-drug interactions with antiretroviral therapy as the drug is rolled out in South Africa. Bedaquiline - the first new tuberculosis (TB) drug to receive FDA approval in 40 years - has not been well studied in patients with extensively drug-resistant (XDR) TB or in TB patients co-infected with HIV.

See more at: http://www.einstein.yu.edu/news/releases/1112/einstein-faculty-receive-first-time-nih-research-project-grants/#sthash.hQpE6Yxo.dpuf


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