Strains of tuberculosis (TB) that are resistant to both first-line and second-line drugs could threaten the success of not only tuberculosis programs, but also HIV treatment programs worldwide, according to an article published online this week in The Lancet. The report details a study by a team of investigators from the United States and South Africa, who found that highly resistant strains of TB were more common than previously thought in a rural area of KwaZulu Natal, South Africa, and were associated with high death rates in patients with HIV infection. TB accounts for approximately 1.7 million deaths worldwide, each year, and is the leading cause of death in HIV-infected patients in low-income countries.