RESUMO
La historia de las intervenciones y de la evolución epidemiológica de la hiperendemia de la tuberculosis multirresistente (TBMDR) comprende el periodo 1987-2016 y continúa. Un primer problema consistió en admitir su transmisibilidad y la necesidad de medir la magnitud. Durante los años 1990 una subestimación de la magnitud permitió su expansión. Durante los años 2000 se universalizaron las pruebas de sensibilidad, alentadas por la Unidad Técnica de TBMDR del ex-Programa Nacional de tuberculosis del Ministerio de Salud peruano. Durante todo ese lapso se han ensayado diferentes esquemas de tratamiento, con resultados dispares, mostrando persistente eficacia únicamente los esquemas individualizados basados en por lo menos tres drogas nuevas. Gracias al apoyo del Fondo Mundial, los pacientes tuvieron acceso universal al tratamiento. Ambas intervenciones impactaron sobre la tendencia de la hiperendemia, deteniendo su expansión. Limitaciones en los últimos años, incluyendo nuevamente una subestimación del mismo ha permitido su rebrote. Así, Perú es el país con mayor severidad de TBMDR y tuberculosis extensamente resistente en América
The history of interventions and the epidemiological history of the hyperendemicity of multi-drugresistant tuberculosis (MDRTB) encompasses the 1987-2016 period, and it still continues. The first problem was to recognize its transmissibility and the need to measure its real magnitude. During the 90s, the condition expanded because its extent was underestimated. During the first decade of the new millennium, universal access for susceptibility testing was granted, with the support of the Technical Unit of the former National Tuberculosis Control Program of the Peruvian Ministry of Health. During the whole period, different therapy schedules have been tested, with dissimilar results, and only individualized regimens with at least three new drugs were shown to be persistently efficacious. Thanks to the support of the World Fund, patients were able to get universal access to therapy. Both interventions had an impact upon the hyperendemic trend, and the expansion of this was stopped. However, some limitations occurring in the latter years, including an underestimation of the real magnitude of the problem, have led to a rebound in this condition. Consequently, Peru is the country with the most severe cases of MDR TB and extremely resistant tuberculosis in the Americas
