A TB epidemic in Russia fanned by a rapidly growing number of HIV infections has the potential to spread multi-drug-resistant TB worldwide, according to a U.S. TB expert. HIV infections are growing faster in Russia than anywhere else in the world, said Dr. Lee Reichman, executive director of the New Jersey Medical School National Tuberculosis Center and co-author of "Time Bomb, The Global Epidemic of Multi-Drug Resistant Tuberculosis." "When the HIV epidemic hits the pool of latent TB infections, there's going to be an explosion of MDR-TB. TB and HIV are like gasoline and a match," said Reichman.

TB can be one of the first signs of HIV infection, while HIV infection can quickly turn a latent TB infection normally controlled by a patient's immune system into active, infectious TB, according to Reichman. TB also accelerates the progression of AIDS and is the biggest killer of AIDS patients worldwide.

Overcrowded Russian prisons are incubating both TB and HIV. Many inmates with TB develop resistance to two or more of the four main antibiotics used in treatment. Of 300,000 prisoners released each year, 30,000 have active TB and 10,000 have MDR-TB, said Reichman. In addition, there is little or no medical follow-up after release from prison.

Reichman noted that the 500 million international travelers going through 5,000 international airports each year adds to the risk for everyone. MDR-TB has already been reported in 43 states, he added.

The solution to TB control lies in political will, said Reichman. "You've got to convince governments that TB is important and that TB in Russia is important. Because to control TB anywhere, you've got to control it everywhere."

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