PHA-Exch> CAPE TOWN CONFERENCE: Simple measures could radically reduce TB

[Claudio Schuftan]

From: RKoppenleitner RKoppenleitner at t-online.de


1 - GLOBAL: Simple measures could radically reduce TB

CAPE TOWN, 14 November (PLUSNEWS) - Better healthcare measures could curb
the tide of tuberculosis (TB) and other lung diseases, even with existing
drugs and technology. This was the final message from the 38th World
Conference on Lung Health, in Cape Town.

At the conclusion of the 4-day meeting this week, Nils Billo, executive
director of the International Union against Tuberculosis and Lung Diseases
(The Union), said that improving infection control, even using simple and
cheap methods, could significantly reduce the spread of tuberculosis (TB)
and its death toll, especially among people with HIV.

However, the 3,000 delegates heard that better drugs and vaccines for
treating and preventing TB, and faster and more accurate diagnostics were
needed if the disease were to be eradicated. Much of the research into
finding effective, practical and affordable technologies is being done by
not-for-profit partnerships, funded by government, donors and the private
sector.

TB has suffered from a lack of attention by policy-makers and funders for
decades because the disease was relatively well contained in developed
countries. However, an outbreak of TB in New York in the 1990s, combined
with the growing toll of TB among people with HIV/AIDS, has been putting the
disease on policy and research agendas.

Diagnosing TB can be difficult, especially where healthcare facilities have
limited or no access to expensive machinery such as x-ray machines, or
laboratories capable of the lengthy culturing of sputum samples to detect
the bacillus.

Better diagnostic tools, like fluorescent microscopes, are already available
but have not been widely adopted because they require expensive lamps and a
stable power supply, but researchers have successfully experimented with
substituting the lamps with 1-watt light-emitting diodes.

Six promising TB vaccines are also being shepherded towards human clinical
trials within the next year, but even if one of them proves sufficiently
effective, it is unlikely to be available for worldwide use before 2015.

The Global Alliance for TB Drug Research announced that it has two new drugs
for treating TB in development; one of them, moxifloxacin, is among the most
advanced potential new TB drugs, and is about to go into a phase 3 clinical
trial involving more than 2000 volunteers in Kenya, South Africa, Tanzania
and Zambia.

The organisation hopes its new antibiotic will eventually be used as a
substitute for existing medications, and help shorten the current 6-month
treatment period with first-line drugs.

Unfortunately, moxifloxacin is not effective against highly drug-resistant
forms of TB. The rising number of drug-resistant cases was a focus of this
year's Lung Conference, along with the spread of TB among HIV-positive
people.

TB cure rates are low worldwide, but particularly in developing countries
with high burdens of the disease, often fuelled by HIV/AIDS. In South
Africa, successful treatment for TB varies widely across provinces and
districts: one district in Mpumalanga Province has reported cure rates of
just 12 percent, compared to a national success rate of just under 58
percent, which is already well below the target of 85 percent recommended by
the WHO.

Drug-resistant forms of TB have been driven by unsuccessful first-line TB
treatment, with many patients failing to complete the 6-month course of
medication. Much of the transmission of resistant strains of TB occurs in
healthcare settings.

Multidrug-resistant (MDR) TB is resistant to at least two of the most
effective and commonly used first-line treatments for the disease, while
extensively drug-resistant (XDR) TB is also impervious to at least one of
the second-line drugs. Worldwide, it is estimated that four percent of TB
infections are resistant to multiple drugs, although the figure is as high
as 20 percent in some areas.

The WHO says it needs US$2.15 billion to fully implement its MDR-TB and
XDR-TB Response Plan 2007-2008. This could potentially save 134,000 lives
over the 2-year period by treating 160,000 people with MDR forms of the
disease, and another 16,000 with XDR-TB.

An estimated 14 million people worldwide are co-infected with TB and HIV,
while more than two-thirds of people infected with TB in sub-Saharan Africa
are also living with HIV/AIDS. The two diseases reinforce each other in the
body, each weakening the immune system's defences against the other.

Conference delegates heard of the critical need to co-ordinate action
against both diseases, to create an effective response to what some
presenters characterised as an epidemic of co-infection. Speakers repeatedly
pointed out that the fight against TB has been relatively poorly resourced,
compared to the more high-profile HIV/AIDS fight.

On the day the Lung Conference ended, the Global Fund to Fight Aids, TB and
Malaria announced US$1.1 billion in new grants, but TB accounted for only 10
percent of funding, compared to 48 percent for HIV/AIDS and 42 percent for
malaria.

Among the calls for action at the conference was to make greater use of one
of the most effective anti-TB drugs, Isoniazid, (also called isonicotinyl
hydrazine, or INH). Research in Brazil found that it could prevent TB
infection in HIV-positive patients by up to 75 percent, if used in
conjunction with antiretroviral therapy.

But presenters also emphasised the positive impact that better healthcare
management could make, including basic steps to prevent the spread of TB in
healthcare settings: opening windows, reducing the number of TB patients in
a ward, and even simply separating coughing - and therefore potentially
infectious TB patients - from others.

The 2008 World Conference on Lung Health will take place in Paris.

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