Tuberculosis

The Washington Post has a new report today exploring the spread of MDR-TB– a multi-drug resistant form of the infectious disease– across Peru. Up close and personal stories like these are really important in understanding the day-to-day impacts diseases like TB have on communities.

You can read the Post’s full report here; video below

Reuters has a report on a new study that suggests that treating AIDS and tuberculosis simultaneously could save more than twice as many lives as going after tuberculosis first would:

About 33 million people worldwide are infected with HIV, the AIDS virus, and 9.2 million have recently been diagnosed with lung-destroying tuberculosis, according to the World Health Organization.

In many cases, HIV’s suppression of the immune system allows the deadly tuberculosis bacterium to thrive. In South Africa, about 73 percent of TB patients also have HIV.

Yet doctors have been reluctant to treat both at once, often choosing to go after TB first. They have been concerned about drug interactions, overlapping side effects and the large number of pills that patients have to take each day.

“You add to the risk of side effects very substantially,” Dr. Salim Abdool Karim of the University of KwaZulu-Natal, in Durban, South Africa, said in a telephone interview.

Treating TB requires months of antibiotics. HIV is incurable and patients must take cocktails of antiviral drugs for life.

“What you don’t want is patients stopping the TB drugs,” Karim said. “So most doctors treating a patient with TB and HIV prefer to finish with the TB drugs and then start on the antiretroviral drugs.”

They tested more than 600 patients with both TB and HIV.

The death rate was 5.4 percent a year for the volunteers who got treatment for both infections, compared with 12.1 percent for those whose TB was treated first, with HIV therapy beginning about six months later.

The results were so convincing that they already prompted the WHO to change its guidelines to call for treating both conditions at the same time.

You can read more details here.

The U.S. recently reported its first ever case of extremely drug-resistant tuberculosis (XXDR-TB), a form of TB that is resistant to all first- and second-line drugs, making it nearly impossible to treat.

Oswaldo Juarez, a Peruvian student who was in Florida to study English, was diagnosed with the disease and discharged from A.G. Holley State Hospital in July 2009 after 19 months of intensive treatment.

Drug resistance is caused by overuse or misuse (e.g., stopping treatment early or using counterfeit or expired drugs) of medicine. In the continuum of resistance, TB’s stages are as follows: simple TB (TB), multi-drug-resistant TB (MDR-TB), extensively drug-resistant TB (XDR), and extremely drug-resistant TB (XXDR-TB). Only a handful of XXDR-TB cases, the most severe form of TB, have ever been diagnosed.

The AP quoted David Ashkin, the physician who treated Juarez, as saying, “When he first came in we really had to throw everything and the kitchen sink at him … It was definitely cutting edge and definitely somewhat risky because it’s not like I can go to the textbooks or . . . journal articles to find out how to do this.”

This case illustrates the rising global challenge of growing drug resistance and the spread of infectious disease. Infectious diseases like tuberculosis know no borders and put citizens around the world at risk. As Dr. Thomas Frieden, Director of the U.S. Centers for Disease Control and Prevention noted, “We are all connected by the air we breathe, and that is why this must be everyone’s problem.”

An estimated 1.3 million people worldwide die from tuberculosis every year – nearly 360,000 of these deaths occur in sub-Saharan Africa.

The 2009 WHO Global Tuberculosis Update was launched earlier this month, providing the latest information on the state of the epidemic around the world. The report shows that in the last 15 years, 36 million people have been cured of tuberculosis, and eight million cases have been prevented. This progress attests to the effectiveness of the Stop TB Strategy and DOTS in the fight against tuberculosis.

During the latest 12-month reporting period, 2.3 million infectious patients were cured, more than ever before in that time frame. Still, not enough people are accessing the treatment they need, and about 1.8 million people died of tuberculosis in 2008.

There were an estimated 9.27 million incident cases of TB in 2007 (of which, 15% percent were among individuals who were also HIV-positive), a slight increase from 9.24 million in 2006. However, while the total number of TB cases is up due to population growth, the number of cases per capita is actually down 1%.

The report shows further progress in addressing the deadly combination of TB and HIV. TB remains the leading cause of death for those with HIV, but testing TB patients for HIV is on the rise, and more patients are receiving appropriate treatment.

The report also notes that there has been little progress in stopping multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB), an even more dangerous and resistant to treatment form of TB.

To learn more, you can read the full report, as well as the WHO’s press release.

Today on Capitol Hill, the Global Health Council held a special panel to discuss the work being done in the global fight against tuberculosis. Production of a new vaccine is underway and three distinguished speakers, Dr. Videlis Nduba, Dr. Harriet Mayanja-Kizza, and Dr. Sizulu Moyo outlined the considerable impacts of the disease and what organizations in Africa are doing to produce a safe and effective vaccine.

With the rise of HIV infection, instances of tuberculosis have also increased as those with weakened immune systems cannot fight off the disease. Dr. Sizulu of the South African Tuberculosis Vaccine Initiative pointed out that in 2007, 73% of new Tuberculosis infections were in those who already had HIV. She also reminded the audience that this is no longer a disease only affecting the developing world as the bacteria can easily be carried, spread through the air, and contracted without the carriers expressing symptoms.

A new tuberculosis vaccine is vital. Diagnostics for the illness are over 100 years old and the current vaccine for TB is 90 years old and protects only some children and no adolescents or adults. However, investigations for a new vaccine are making progress. Dr. Nduba of the Kenya Medical Research Institute (KEMRI) is hopeful that a vaccine may be available as early as 2016. KEMRI along with Centers for Disease Control and Prevention also use mobile facilities, mobile ex-ray trucks, and laptops to screen thousands of adolescents and infants in Kenya for TB. Dr. Mayanja-Kizza, Professor of Medicine at Makerere Uninversity in Uganda, spoke of the University’s partnership with AERAS Global TB Vaccination Foundation. Along with building clinics, the organizations train field workers, nurses, and community leaders to ride motorcycles into communities to screen infants for the disease and sensitize communities to information on TB.

The South African Tuberculosis Vaccine Initiative (SATVI) established in 2001, is at the forefront of vaccine research in developing a safer, more effective TB vaccine. Dr. Sizulu mentioned that such a discovery between 2014 and 2018 could reduce TB in Africa and Asia up to 40% by 2050. There is still much work to be done but the fight against tuberculosis is gaining ground in Africa.

The live webcast on the U.S. government’s strategy for combating the global TB epidemic will start in approximately 30 minutes. You can watch and participate here.

Here’s a note from the Kaiser Family Foundation, who’s hosting the broadcast:

TB is preventable and curable, but today remains one of the world’s major causes of illness and death. Most of those affected are in developing countries, particularly those in Asia and Africa. The U.S. stepped up its efforts to address TB in the late 1990s, and funding has increased – rising from $87 million in fiscal year 2004 to $175 million in 2009. Now is a particularly important time to look at the U.S. role in combating TB moving forward. The Administration is currently planning a broad, new Global Health Initiative, which will focus on integration and coordination of the U.S. global health portfolio and Congress, through PEPFAR Reauthorization, has mandated the development of 5-year TB strategy. Both these processes are underway.

Today at 1 p.m. ET, the Kaiser Family Foundation, as part of its In Focus series, will hold a live, interactive webcast with experts to discuss the status of the TB strategy, how it fits into the overall global health initiative, and key challenges on the horizon. In addition to featuring Cheri Vincent from USAID and Dr. Christine Sizemore from NIH, we’ll hear from Christine Lubinski of the Center for Global Health Policy and Dr. Robin Wood from the University of Cape Town about his experience on the ground in South Africa. Full details about the event are here: .

Email questions to us now or during the live webcast at infocus@kff.org.

-Jen Kates, The Kaiser Family Foundation

We wanted to be sure to let you know about a live, interactive webcast hosted by the Kaiser Family Foundation tomorrow at 1 pm EST. The webcast will feature a panel of experts discussing U.S. strategy to combat the global tuberculosis (TB) epidemic.

According to Kaiser,

TB, a preventable and curable disease, remains one of the world’s major causes of illness and death, resulting in close to 2 million deaths in 2007. The majority of TB cases and deaths are concentrated in developing countries, particularly those in Asia and Africa. During this live webcast, the panel will discuss the U.S. government’s global response to TB, including the status of a Congressionally-mandated five-year global TB strategy, how such a strategy will be integrated into the administration’s new, broader, Global Health Initiative, and key challenges that remain – such as the link between HIV and TB – in combating the disease around the world.

We’ll post the link to the webcast when it becomes available approximately 30 minutes before it begins.

Just when you thought “Ratatouille” would be the highlight for these long-tailed rodents, the organization APOPO has trained African rats to diagnose pulmonary tuberculosis (TB). Using scent detection, these HeroRAT’s can reliably (50 percent higher reliability than traditional microscopy) process 40 sputum samples in seven minutes, a task that takes trained lab technicians an entire day.

This innovative means of ‘ratting out’ pulmonary tuberculosis presents a unique way to enhance TB case detection in resource limited settings.

To learn more, read the original article here, and check out ONE’s tuberculosis brief here.

-Rena Pacheco-Theard

The Global Fund to Fight AIDS, Tuberculosis and Malaria announced today that it has helped put 2.3 million people on life-saving treatment for HIV/AIDS (a 31 percent increase over results reported last year), treated 5.4 million people for tuberculosis (a 38 percent increase over last year), and distributed 88 million insecticide-treated bed nets (a 49 percent increase from this time last year) to protect against malaria since it was created eight years ago.

These inspiring results constitute 30-50 percent increases in treatment and prevention measures in just one year. As Michel Kazatchkine, Executive Director of the Global Fund, commented, “In less than eight years, the Global Fund has gone from a concept to a driver of change.”

The Global Fund’s latest results attest to its effectiveness in the prevention and treatment of AIDS, tuberculosis, and malaria. It is imperative that the $3 billion funding shortfall currently facing the partnership is filled by donors.

To learn more about the Global Fund’s impact, read their press release here.

-Rena Pacheco-Theard

At a congressional briefing last Thursday, leading global health experts pushed for stronger U.S. leadership and more aggressive global policies to combat HIV/TB co-infection worldwide. The hearing coincided with the Center for Global Health Policy’s release of “Deadly Duo: The Synergy Between HIV/AIDS & Tuberculosis”, which echoed many of the main points of the briefing. The discussion, moderated by Christine Lubinski, director of the Center for Global Health Policy, included Dr. Diane Havlir, Professor of Medicine at the University of California, Dr. Carol Hamilton, co-chair of the Center’s Scientific Advisory Committee, and Rosemary Mburu, advocacy and policy coordinator for Kenya’s AIDS NGO Consortium (KANCO).

Both the hearing and the report warned that the recent success of HIV treatment is at risk due to the spread of tuberculosis. In the past two decades, the number of new cases of TB in HIV-prevalent countries has tripled – TB is now the number one killer of those infected with HIV in the developing world. Within two weeks of contracting HIV, Dr. Havlir explained, the risk of also contracting TB doubles. These catastrophic consequences of co-infection require immediate action.

The panelists emphasized the need to improve and ramp-up antiretroviral treatment, diagnostic tests, and research and development. Dr. Havlir also urged an earlier start for treatment. This early start, Havlir explained, would have dual benefits – it would improve survival rates of HIV-positive patients as well as lower the risk of contracting TB. Dr. Hamilton explained that outdated drugs, diagnostics, and vaccines are becoming less and less effective at combating the spread of TB. Even more dangerous, TB strains are developing faster than the drugs to combat them, resulting in drug-resistant strands of TB.

Mburu provided a face to the disease, recounting personal stories from the ground. A lack of labs to diagnose drug-resistant TB, compounded by a lack of accessibility to treatment and a lengthy delay in test results is causing an increase in TB deaths. “People are living with HIV, but it is TB that is killing them,” Mburu explained.

Lubinski ended the briefing with an aggressive call to action. She urged attendees to, “re-invigorate the energy [and] the passion” from HIV/AIDS research and development to fight against the increasingly disastrous consequences of TB.

Check out a webcast of the briefing here.

-Pooja Gupta