TreatmentThe World Health Organization (WHO) recently recommended two changes in the treatment of MDR-TB (multidrug-resistant tuberculosis): a new rapid diagnostic test and a shorter, cheaper treatment regimen.

The rapid diagnostic test is a DNA-based test that identifies genetic mutations in MDR-TB strains that make them resistant to second-line drugs. Second-line drugs are the most important drugs used in the treatment of MDR-TB, fluoroquinolones and injectables. If patients resistant to second-line drugs are treated with either the current or the new recommended regimen, then their MDR-TB risks evolving into extensively drug-resistant tuberculosis.

Unlike the previous diagnostic test, which took three or more months to produce results, this new test will deliver results in 24 to 48 hours.

Because the rapid diagnostic test detects how resistant a patient’s tuberculosis is to treatment, it can determine a patient’s eligibility for the new regimen that WHO recommends. Ideally, patients with uncomplicated MDR-TB (patients not diagnosed with a strain of tuberculosis that is resistant to second-line drugs) will be the ones using the new regimen.

The new treatment regimen, which was developed by the International Union Against Tuberculosis and Lung Disease (The Union), takes only half the time and is almost half the cost of the current regimen according to Dr. Mario Raviglione, the director of WHO’s Global TB Program.

Currently, the treatment of MDR-TB takes between 18 to 24 months to complete. Dr. ID Rusen, a senior vice president of The Union, told The Guardian that this equates to 14,000 pills over two years for only one person, all for a regimen that, according to WHO, has a cure rate of less than 50 percent.

WHO stated that the low success rate is due to the side effects patients undergo after taking second-line drugs for an extended period of time. In a Huffington Post article, Dr. Ariel Pablos-Mendez of USAID and Raviglione wrote that the side effects include debilitating nausea, vomiting and heaving, as well as vision loss and depression paired with suicidal thoughts. These difficulties, coupled with the financial difficulties many people experience as they try to pay for the current regimen, often cause people to interrupt their treatment.

The new treatment regimen that WHO recommends takes only nine to 12 months, and it costs less than $1,000. The shorter time frame and lower cost are expected to help people finish treatment, and the rapid diagnostic test will help them receive treatment more quickly. Less time and money spent on treatment for one person also frees up resources, so even more people will be able to receive the necessary care.

Though the new regimen has not gone through formal clinical trials, WHO has confidence the regimen works. It was tried successfully in 515 patients in Bangladesh between 2005 and 2011, then on 408 people in various African nations. Raviglione told The Guardian that WHO was accelerating the procedure because they feel the new regimen has “real potential to save lives immediately.”

Anastazia Vanisko

Photo: Flickr

Tuberculosis (TB) is responsible for 4,000 deaths daily, killing more adults around the world than any other infectious disease. Here are some key facts on TB:

  • According to the World Health Organization (WHO), 9.6 million people developed TB in 2014 and 1.5 million died as a result of the curable and preventable disease.
  • More than 95 percent of TB cases and deaths occur in developing countries.
  • Caused by bacteria, TB is spread from person to person through the air.
  • The WHO reports that about one-third of the world’s population has latent TB, meaning a person is infected by the bacteria but is not symptomatic and not transmitting the disease.
  • Between 2000 and 2014, an estimated 43 million lives were saved through TB diagnosis and treatment.

Tackling Multidrug-resistant TB

Unfortunately, after decades of use, anti-tuberculosis drug resistance is becoming widespread. Disease strains that are resistant to a single anti-TB drug have been documented in every country surveyed by WHO.

Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to Isoniazid and Rifampicin, the two most common anti-TB drugs.

The primary cause of MDR-TB is inappropriate treatment. Inappropriate treatment ranges from an incorrect use of anti-TB drugs to the use of poor quality medicines.

“If we don’t act promptly, if we don’t act now, then the problem of drug-resistant TB will just get worse,” reported Peter Cegielski, team leader for Drug-Resistant TB and Infection Control in the global TB branch at the CDC.

The U.S. Agency for International Development (USAID) reported this year alone more than 480,000 people will develop MDR-TB and fewer than 20 percent will receive the medications they need.

The USAID responded to this global health concern by announcing two new partnerships to add resources and cutting-edge technology to fight drug-resistant tuberculosis.

Janssen, the pharmaceutical arm of Johnson & Johnson, announced a $15 to $20 million pledge to combat MDR-TB. Cepheid, a maker of molecular systems and tests, is also teaming with USAID in an effort to increase access to rapid, accurate diagnostic tools.

“USAID remains committed to addressing the global rise of MDR-TB,” Dr. Ariel Pablos-Méndez, USAID Assistant Administrator for Global Health, said. “With the successful implementation of this plan, we have an incredible opportunity to make a significant impact on the emergence and spread of MDR-TB. We will continue to harness mutually rewarding partnerships, like the ones with Janssen and Cepheid, to lead international efforts against MDR-TB.”

Kara Buckley

Sources: USAID, VOA News, WHO
Photo: All Africa

Tuberculosis (TB) has reportedly fallen by almost half (47 percent) since 1990 through early diagnosis and treatment. However, TB is still a leading cause of death today, with approximately 4,000 individuals succumbing to its effects daily, according to the World Health Organization’s (WHO) 2015 Global tuberculosis report.

TB affects all walks of life around the world; however, there is a link between this disease and poverty, as 95 percent of all cases occur in low- or middle-income countries.

These figures are not surprising because many individuals living in developing countries are more likely to lack accessible or affordable health care and, therefore, are unable to seek treatment.

It is the failure to treat tuberculosis that has contributed to the alarming number of infections the world saw last year, with 9.6 million people being infected by the disease and 1.5 million dying from it.

Fortunately, the WHO has been working hard to address the number of cases globally and has saved the lives of an estimated 43 million individuals across the world from 2000 – 2014 alone.

About one-third of the entire world’s population is infected with latent TB, a condition of TB in which an individual carries the bacterium but has not yet fallen ill.

With latent TB, the symptoms often last months before worsening into a bloody cough that most notably characterizes the disease. As a result, many individuals infected with latent TB often delay getting early treatment.

In order to combat this, the WHO recommends a six-month treatment of four separate antimicrobial medications that deal with drug-susceptible TB which has proven to work with a majority of cases so long as the instructions and precautions are strictly adhered to.

Another form of TB (MDR-TB) has emerged after decades of successful treatments; this version is resistant to the two most powerful forms of anti-tuberculosis medicines.

This form of TB is a growing threat to the battle to end the disease that could undo the work of the past few decades. A new method, however, ushers in a new era for the diagnosis of TB by providing definitive results in less than two hours.

According to the National Institutes of Health, Dr. David Alland of the University of Medicine and Dentistry of New Jersey led a group of researchers and invented the Xpert MTB/RIF test to aid in the diagnosis of not only TB but also drug resistance in TB to discern viable options available for patients.

Hopefully, this will be the beginning of the end for tuberculosis.

Emilio Rivera

Photo: Google Images