E-DRUG: MSF: New approach needed for drug-resistant TB
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[copied as fair use; WB]
'New approach needed' for drug-resistant TB
Byline: South African Press Association/DPA
November 06 2007 at 06:34PM
http://www.int.iol.co.za/index.php?set_id=1&click_id=125&art_id=nw20071106104459742C510117
The international medical aid organisation Medecins sans Frontieres (MSF)
on Tuesday backed calls for a new approach to the treatment of deadly
drug-resistant tuberculosis, which is spreading rapidly among HIV patients
in Sub-Saharan Africa.
The changes should include an end to isolating TB patients in hospital
wards for long periods of time - a practice MSF called counter-productive.
Instead, they could be treated in their communities with individualised
plans of treatment, MSF said.
MSF was repeating its past calls for an end to the isolation ward
treatment, a policy blamed for violent rioting by patients at a TB
hospital in Gauteng province last week.
"The reality is exploding in our faces," said Dr Eric Goemaere, MSF's head
of mission in the sprawling Khayelitsha township outside Cape Town.
He was referring to the high prevalence of drug-resistant TB in South
Africa, the country with the largest number of HIV infections.
TB is most frequent cause of death among the estimated 24,7 million people
with HIV in Sub-Saharan Africa.
Multi-drug-resistant TB (MDR-TB) occurs in patients that are resistant to
the two most powerful first-line TB antibiotics. These patients have a
less-than-50-per-cent chance of survival.
Poor TB control programmes - including patients' not finishing their
treatment - are usually blamed for the development of drug-resistance. But
over the past two years, 30 per cent of more than 200 patients who
developed drug-resistant TB in Khayelitsha had never had TB before,
Goemaere noted.
One in 10 MDR-TB patients goes on to develop resistance to two classes of
second-line drugs, and becomes ill with a form of the disease called
extensively-drug-resistant TB (XDR-TB), which is almost impossible to
treat.
Drug-resistant TB has been around since the 1940s but is aggravated in
countries with a high HIV prevalence, according to Harvard Medical
School's Carole Mitnick.
The World Health Organisation estimates the number of new drug- resistant
TB cases at 450 000 each year. South Africa, where around one in five
adults is HIV-positive, has about 6 000 new MDR-TB cases per year.
MSF backed calls from Mitnick and other US experts in a report in
Tuesday's edition of PLoS Medicine for MDR-TB patients to be included in
clinical trials of new TB drugs. The magazine is available online as an
open-source medical journal.
"This is quite simply the best hope we have of getting improved medicines
to patients with multi-drug-resistant TB faster," Goemaere said. "We
cannot afford to wait."
Until now donors had been focusing on the long-term goal of a complete new
first-line treatment for both drug-resistant and normal TB, said Dr Tido
von Schoen-Angerer, head of MSF's Access to Essential Medicines Campaign.
This would likely take another decade or two.
In the meantime, new trials were needed to achieve "some improvement in
the desperate situation for MDR-TB treatment" by determining
individualised treatment regimens for each patient.
Contrary to the belief that isolation was necessary to prevent the spread
of the infection, it was "probably the worst strategy", except in extreme
cases, said Goemaere.
A recent report in the British medical journal Lancet showed that the
first outbreak of XDR-TB in South Africa in 2005/2006, which claimed the
lives of 52 out of 53 patients, was driven by infections that occur in
hospitals, he pointed out.
Delays in diagnosis and obtaining a hospital bed also meant that MDR and
XDR-TB patients had plenty of time to infect others before being isolated.
In addition, patients were stigmatised because they spent two years in
isolation. They suffered from side-effects such as deafness, kidney
problems and severe nausea, from the medicine, leading to a total
breakdown in understanding between doctors and patients, he said.
MSF repeated its past calls for a strategy that would allow TB patients to
remain within their community by developing infection control mechanisms,
schooling people in cough etiquette and improving ventilation in clinics
and minibus taxis.
The run-up to the 38th Union World Conference on Lung Health in Cape Town
on November 8-12 has been marked by a raft of position papers on TB and
HIV/TB co-infection from health experts and NGOs.
Around 3 000 delegates are expected at the conference, which will hear
calls for a new, combined approach to the HIV/TB co-epidemic, including
the need for a TB vaccine, new drugs and diagnostic tools.
The experts writing in PLoS Medicine also called for improved funding for
TB research, particularly new drug development, and towards building
capacity for countries with a high TB burden to hold clinical trials. -
Sapa-DPA
Associated Press
Thousands Gather at TB Meet in S. Africa
November 7, 2007 Wednesday 1:24 PM GMT
By CLARE NULLIS, Associated Press Writer
DATELINE: CAPE TOWN South Africa
Old drugs. Outdated tests. Empty promises. New threats. Such is the bleak
reality surrounding an international tuberculosis conference opening
Thursday in a city scarred by a killer combination of TB and AIDS: an
already nightmarish scenario worsened by the spread of untreatable
strains.
The 3,000 delegates will spend four days discussing the challenges posed
by the dual epidemics of TB and HIV which are still often treated
separately although they feed off each other. About one-third of the
world's 40 million people infected with the AIDS virus have TB, the vast
majority of them in Africa. TB kills more than 1.6 million people every
year.
"Unlike bird flu, the global threat of HIV/TB is not hypothetical. It is
here now. But the science and coordination needed to stop it are utterly
insufficient," said Veronica Miller, director of The Forum for
Collaborative HIV Research, in a report released ahead of the Cape Town
conference.
The only available vaccine was invented more than 85 years ago and fails
to protect most people beyond childhood. Antibiotics used to fight TB are
more than 40 years old. Test methods used in most developing countries
were developed 120 years ago, are notoriously slow and often fail to spot
TB in AIDS patients.
Health activists charge that rich countries and their pharmaceutical
industries have shown little interest in developing more effective drugs
because TB primarily affects poor people in poor countries. There are some
new drug development and diagnostics initiatives but the activists say
it's too little too late.
In a report issued Wednesday, the New York based advocacy Treatment Action
Group accused the United States and other donor nations of backsliding on
commitments made last year to step up the fight against TB.
It said that international spending for TB research and development
remained stagnant at US$413 million less than half the amount called for
in a much-vaunted 2006 Global Plan to Stop TB to increase funding for
research on new TB diagnostics, drugs.
The contribution from the U.S. National Institutes of Health the biggest
funder declined slightly to US$120 million, it said. Mark Harrington,
executive director of the Treatment Action Group, said that with the U.S.
budget problems and overspending in Iraq, TB wasn't "even on the radar" of
the Bush administration.
"Current funding levels for TB research and development are vastly out of
proportion with the scope of the TB epidemic," said Dr. Mario Raviglione,
Director of the World Health Organization's Stop TB Department.
The Treatment Action Group said the lack of funding was especially
alarming given the global spread of multidrug resistant (MDR-TB) and
extensively drug-resistant TB (XDR-TB), which was identified in 2006 and
is now present in more than 40 countries.
The spread of the drug resistant forms of TB is largely the result of
poorly managed TB care and patients who don't take the full six-month
course of treatment.
In South Africa, for instance, the cure rate for patients who stick to
their treatment is just 50 percent, way below WHO's target of 85 percent.
In some areas, it is as low as 30 percent, according to Greg Hussey, head
of the University of Cape Town's Institute for Infectious Diseases. People
who are not properly cured are prone to develop MDR-TB which requires a
two year treatment regimen.
South Africa hit the headlines last year when 53 people at a clinic in
Tugela Ferry in KwaZulu-Natal were diagnosed with HIV/XDR-TB. Nearly all
of them died within two weeks because of their weakened immune systems.
Because of the poor diagnostics, there are no reliable statistics on the
number of South Africans who have been infected with XDR-TB. The majority
of them die before they can be tested or treated, according to Gilles van
Cutsem, a project coordinator for Medecins Sans Frontieres in the poor
Cape Town suburb of Khayelitsha, one of the hardest hit areas.
Little is known about the situation in neighboring countries like
Swaziland and Mozambique, which also have high HIV and TB rates but don't
have proper laboratory facilities. But MSF and other organizations say
they fear the worst.