Drug-Resistant TB Surfaces in Thailand

By, Sai Silp, The Irrawaddy, June 15, 2007

Thai officials have stepped up surveillance and protective measures after 13 Thai citizens and two ethnic Karen migrants from Burma were found to be carrying a dangerous and highly drug-resistant form of tuberculosis.

Dr Thawat Sunthrajarn, director-general of Thailand’s Disease Control Department, said that while infected TB patients needed to be o­n medication continuously for six months o­nly 79 percent diagnosed with the disease in Thailand completed their treatment. The World Health Organization’s required standard was 85 percent, he said.

If treatment were neglected or not completed, the disease built a resistance to the medicine and most patients died, Dr Thawat warned.

Thailand’s Ministry of Public Health adopts various strategies to combat outbreaks of TB and says it insists o­n following up o­n patients and their medication closely. It is common practice to treat TB and HIV together, because 30 percent of HIV patients also have TB.

The ministry has also identified special risk groups such as migrants and people living along border areas and collaborates with international aid organizations working in those areas to tackle the problem.

Recently, the ministry also announced a campaign to promote the use of hygienic masks to prevent the spread of respiratory-transmitted diseases like the common cold, influenza, pneumonia and TB. The current annual budget for treatment of these diseases is about 5 billion baht (US $138,500,000).

The medical aid organization Médecins Sans Frontières has reported that two cases of “Extremely Drug Resistance-TB (XDR-TB)” cases had been diagnosed in Karen migrants from Burma. Dr. Thawat confirmed that o­ne case was found in a refugee camp near Mae Sot o­n the Thai-Burmese border, but said it was believed that the other infected person had returned to Burma and could not be located. He said details of all cases of XDR-TB would be forwarded to the WHO.

A member of staff at the Mae Tao clinic in Mae Sot confirmed that the number of patients with TB entering the clinic has been increasing, although about a half of the people suspected of having TB have to be referred to MSF because the small clinic does not have the facilities to cater for so many patients.

Dr. Manoon Leechawengwong, chairman of the Drug Resistant TB Research Fund, said that the foundation, under the patronage of the Siriraj Foundation, began research into drug-resistant forms of TB in 2001 and had since found 13 cases identified as XDR-TB, according to a report in The Nation. Dr. Manoon warned that respiratory- transmitted diseases could spread easily, particularly in air-conditioned public places in big cities.

The worldwide spread of TB continues to cause concern. In March, the WHO reported that there were 269 XDR-TB cases in 35 countries worldwide. In Thailand, an estimated 91,000 people have TB, 40,000 of whom are contagious. So far in 2007, 10,000 new cases have been diagnosed.


Source: http://www.irrawaddy.org/article.php?art_id=7486

Tuberculosis: Old disease, new danger

By, Tuscaloosa News, June 14, 2007

Last month, health officials quarantined an Atlanta man infected with a type of tuberculosis that resists multiple antibiotics.

Most people probably thought the days of quarantine were over. After all, we have highly effective antibiotics, vaccinations and other public health measures to prevent and treat infectious diseases.

This is the government’s first quarantine in more than 40 years. And it’s not a previously unknown infection. The man has an age-old disease about which we know plenty.

TB is a historic scourge of humankind. Even now, it is the leading infectious cause of death in the world, accounting for more than 2 million deaths a year.

We have been luckier in the United States than in developing countries. Starting in about 1900, improved living standards led to a decline in the disease, which dropped further after the discovery of anti-TB drugs in mid-century. But in 1984, a rise was fueled by HIV and homelessness. We also saw the first cases of multidrug-resistant TB.

Ordinary TB responds to a combination of four drugs for the first two months, followed by two drugs for four more months.

But MDR strains resist the first-line drugs, so treatment requires a complex cocktail of multiple second-line drugs.

In the United States, the risk of both forms of TB plateaued in 1992. The risk has declined steadily since, to an all-time low of about 14,000 cases a year, because of aggressive diagnosis and strict isolation of cases. Most deaths from TB occur when the condition is not diagnosed promptly or because the proper antibiotics are not started in time.

In some ways, the current case is a product of advances in science and technology.

When antibiotic use becomes widespread, bacteria may mutate into a form that resists antibiotics. When drugs for TB were first introduced, drug-resistant strains of the germ were rare. No more. And global travel can spread tough bugs, putting more people at risk.

Most people in the United States probably don’t have to take special precautions to avoid infection with TB.

Experts believe the risk to public health in the United States posed by XDR TB remains quite low.

— Harvard Medical School

Source: http://www.tuscaloosanews.com/apps/pbcs.dll/article?AID=/20070614/NEWS/706140306/1002/NEWS04

What the TB Scare Teaches Us

By, Josh Ruxin, The Huffington Post, June 14, 2007

XDR-TB, or extensively drug-resistant tuberculosis, is a disease many Americans had never heard of before last week, but where I live and work in Rwanda, Multidrug Resistant TB (MDR-TB) is a persistent and growing feature of the public health landscape. While MDR-TB is resistant to at least the two most commonly used drugs, it can generally be treated and cured. XDR-TB is resistant to nearly all drugs and is considered virtually untreatable.

It should not shock Americans that this disease is making its way across the globe when every location is just a plane ride away. Yet the growth of XDR-TB has gone largely unnoticed in the US, where there have only 17 cases since 2000. In sub-Saharan Africa where roughly 25 million people are HIV positive, nearly half will develop TB. If treatment is not well administered, these cases will lead to new strains of resistant TB. There is a direct connection between the AIDS pandemic, TB, and the failure of health systems to appropriately diagnose and treat these diseases.

The good news is that the momentum to address this pandemic may be at hand. It's about time: about a year ago, the World Health Organization announced that 52 of 53 AIDS patients with XDR-TB died in South Africa. The international medical community has now acknowledged the looming problem, and, as witnessed last week, that acknowledgment occurred just when the threat to richer countries has appeared in the unlikely form of Andrew Speaker.

The recognized fact is that more funding and better research are needed now to stanch what may prove to be the next pandemic.

TB has plagued humankind since the 4th millennium BCE. While the disease only recently ceased to be a significant public health threat in the developed world, TB still claims 5,000 lives globally every day, more than SARS, Marburg, and avian flu ever have. Yet even on World TB Day, the disease rarely makes the headlines.

Lack of political and media attention has slowed scientific development. No new TB drug has been brought to market in the last 30 years (though the TB Alliance has promising candidates in the pipeline). A TB vaccine -- BCG -- is widely administered, but is ineffective in adults. Consequently, the disease has become endemic in poor countries where TB programs are underfunded. When a patient receives intermittent drug therapy or inadequate follow-up, or prematurely halts treatment, resistance can occur rapidly. Uneven treatment has resulted in drug resistant TB strains emerging globally. It's now time to address this crisis with the gravity and resources long accorded to AIDS and other diseases.

The first step is improving diagnosis and detection. In 1993, the World Health Organization recognized TB as a global health threat. Yet since then, the Geneva-based organization has continued to rely on an obsolete 125-year-old diagnostic tool -- microscopy. Over the past decade, rapid and accurate tests for TB have been developed but not widely approved. Why then do the WHO and many national TB programs keep outmoded methods as the cornerstone of their control strategies?

The simple reason is cost. Microscopy -- about 30 cents per patient -- is well-suited for most resource-limited settings. However, it cannot detect MDR-TB and XDR-TB. During the last five years, an advanced test, the line probe assay, has been proven effective. Though more expensive than microscopy -- cost estimates place the potential price around three dollars -- it can test many more people, faster, and reveals which treatment is best for their illness.

This test is desperately overdue. Of the 8.9 million new TB cases that emerged in 2004, barely half were reported at the time. An accurate, rapid diagnostic will cost money, but the result -- early treatment and cure -- will save billions of dollars and millions of lives in the long-term.

Treatment protocols also need reform. Right now, we settle for initially treating all TB the same way, shifting gears only after failure. When a person is found to be TB positive via microscopy in Rwanda, the patient receives drugs which may not work at all. It is only after several months have passed that further testing occurs and other drug regimens are applied. That's bad policy since it provides time for resistant strains of TB to spread.

A U.S. Senate committee is currently holding hearings on how health authorities handled Andrew Speaker's case. It is important that Congress and the world not miss the larger frame his case reveals: in an age of global jet travel, there is no such thing as an isolated case. TB anywhere is TB everywhere.

In the fight against XDR-TB, supporting worldwide efforts to fund improved diagnostics and treatment is the best investment we can make. Indeed, it is the only thing we can do.

Josh Ruxin, Assistant Clinical Professor of Public Health at Columbia University's Mailman School of Public Health, is Director of the Access Project in Rwanda.


Source: http://www.huffingtonpost.com/josh-ruxin/what-the-tb-scare-teaches_b_52188.html

Flight plan: TB or not TB

By, James Jay Carafano, Washington Times, June 9, 2007

[Mod’s Note: The international travels of Andrew Speaker, the Georgia resident who is infected with a rare form of tuberculosis, has received wide media coverage, also raising the profile of drug resistant TB]

Washington Post - One of the great combat generals of World War II, Manton Eddy, had a favorite saying when battle reports came in: "Things are never half as good or half as bad as they look at first." Gen. Eddy believed in waiting for enough information to make a good decision. This also applies to homeland security.

Before people start assigning blame, spending money and proposing fixes, they ought to have enough facts to make a respectable guess at the right thing to do. Yet where homeland security is concerned, thinking before speaking seems to be the exception rather than the norm.

It's happening now in the wake of the story about the international travels of Andrew Speaker, the Georgia resident who is infected with a rare form of tuberculosis. His sojourn and his ability to slip past border officials have spawned thousands of newspaper articles and hours of TV coverage as well as accusations that the Departments of Homeland Security and Health and Human Services were at fault.

The only thing we don't have yet are the facts needed to make any really useful assessments about what this story might portend and how to fix the problem.

The first thing necessary to understand is what Mr. Speaker knew about his illness and what various health officials told him to do. So far, the record is contradictory and confusing. But it makes a big difference. In dealing with an infectious disease, the most important instrument of control is the voluntary behavior of individuals. Getting people to do the right thing -- what is in their own best interest and that of the community -- is paramount.

This is an important teaching moment for all Americans. They need to understand the importance of their role in public and the magnitude of their responsibility. Public health officials, must learn how to communicate to citizens so their messages are credible and understandable.

Next, we need a complete timeline of the actions taken by all officials -- not just in the U.S., but in all the countries involved. No one has all the facts yet, and we can't properly evaluate government response without them. For example, news stories have focused on Mr. Speaker's entry into the U.S. across the Canadian border. But how did he get into Canada? If a truly communicable disease crosses the ocean, and the onset of symptoms isn't visibly apparent in a few hours, then likelier than not it will reach the United States, carried by innocents infected in Canada or Mexico who have no idea they are infected.

Finally, the problem needs to be put in perspective. The U.S. already has a communicable disease problem -- big time. And the individuals entering the U.S. legally through legitimate points of entry are the least part of it.

Tuberculosis, including strains increasingly drug resistant, is one of the world's fastest-growing diseases. This is partly due to the spread of HIV/AIDS, which reduces the human immune system, leaving individuals more susceptible to TB.

The World Health Organization says more than 8 million people a year get TB, and about 98 percent live in the developing world. Most illegal migration comes from the developing world to Europe and the U.S. Many of these persons never pass through a point of entry, which is the most likely source of a human-carried pandemic. That's where the real problem is. In fact, today when the Department of Homeland Security detains an individual for removal from the United States, virtually the first step taken is to test him for TB.

That said, as the Senate considers a bill to immediately grant legal status, including the right to pass back and forth across the U.S. border, to about 12 million individuals living unlawfully in the United States -- with no health check required -- the advice to think before acting should hold special significance.

Knee-jerk responses to one individual case make for bad public policy. In evaluating homeland security, sizing up public health policies, and passing immigration laws, we ought to proceed a little more thoughtfully.

James Jay Carafano is a senior research fellow for homeland security at the Heritage Foundation (heritage.org).

Source: http://washingtontimes.com/functions/print.php?StoryID=20070609-101634-2232r

TB Testing, Treatment Should Be Linked With HIV Prevention Programs, WHO Official Says

By, Kaiser Network, June 8, 2007

African countries, especially those in Southern Africa, must link tuberculosis testing and treatment with HIV prevention programs to more effectively fight HIV/AIDS, Kevin de Cock, head of the World Health Organization's HIV/AIDS department, said recently at the 3rd South African AIDS Conference in Durban, South Africa, Reuters reports. De Cock said that the continued use of traditional treatments for TB could fuel the spread of the disease and exacerbate the HIV/AIDS epidemic. "TB programs alone cannot reverse the tide" of HIV/AIDS, he said, adding that it is vital to offer those living with HIV/TB coinfection convenient and effective treatment for both diseases.

The emergence of extensively drug-resistant TB, which is resistant to the two most potent first-line treatments and some of the available second-line drugs, in South Africa's KwaZulu-Natal province, neighboring Lesotho and other parts of the world has created a more serious threat, especially in Southern Africa, where HIV/AIDS and TB are prevalent and interlinked. In South Africa, approximately 61% of the roughly 250,000 people diagnosed annually with TB have HIV, Reuters reports. XDR-TB also has led to higher mortality rates and faster deaths among HIV-positive people, according to Reuters. In addition, although people living with HIV/TB coinfection might have access to antiretroviral drugs, they often do not receive treatment simultaneously for both diseases.

Robin Wood, director of South Africa's Desmond Tutu HIV Center at the University of Cape Town, said, "HIV has caused a devastating reversal in our ability to treat TB." He added that the solution is to combine HIV and TB treatments, which will require a large investment in TB laboratories, as well as related medical infrastructure and resources, in much of Africa. Researchers are developing a urine-based dipstick test that would give TB results almost instantly. Wood said this "would be a great asset if we could get it" (Simao, Reuters, 6/7).


Source: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=45457

Traveling tuberculosis patient hits back at critics

By, Denise Grady, International Herald Tribune, June 10, 2007

"TB SPREADS THROUGH THE AIR, BUT ONLY A SMALL PERCENTAGE OF PEOPLE WHO ARE EXPOSED TO THE BACTERIA ACTUALLY GET SICK. XDR-TB IS NOT MORE VIRULENT OR MORE CONTAGIOUS THAN OTHER TYPES, BUT IT IS OF GREAT CONCERN BECAUSE IT IS SO DIFFICULT TO TREAT"

"WHEN I'M DONE WITH ALL THIS, AM I GOING TO HAVE A PRACTICE [LAW] TO GET BACK TO, WITH THE IMPRESSION OUT THERE NOW THAT I'M THIS SELFISH, SELF-ABSORBED PERSON?"

By the time Andrew Speaker and his wife returned to the United States from Europe late last month, government officials and news reports had already branded him as a runaway tuberculosis patient who had deliberately evaded health officials and knowingly put other people at risk by traveling on crowded airplanes.

"This is what we're hearing on the news when we land," Speaker said Thursday from his hospital room in Denver. He called The New York Times in response to repeated requests for an interview. "My wife and I look at each other, and I said, 'They're going for our throats here.' "

Speaker and his family have been fighting back ever since, disputing the accounts of government health officials who contended he had been warned not to fly because he posed an infection risk to others.

"I think when they started all this, they forgot that I spend my whole life defending people who are seriously hurt and need help," said Speaker, 31, a personal injury lawyer. "I don't think they took that into account when they started coming after me and my family. We're not the kind of people who back down."

Speaker's father, Theodore, also a lawyer, went so far as to record conversations with health officials, and to release selected excerpts from the recordings in which a doctor from the Fulton County Health Department in Georgia can be clearly heard saying, "You're not contagious" and, "As far as we can tell you, you're not a threat to anybody else right now."

Speaker declined to release the complete recordings, saying they included personal medical details that were "none of anybody's darn business."

During the interview, Speaker spoke at length, expressing anger, frustration and worry about his reputation and career. He accused health officials of trying to destroy his credibility to cover their own mistakes in handling his case. They themselves never wore masks around him, he said, and never told him that he posed any risk to his family.

"If I'm a danger to people in close contact, shouldn't they have told me I was a threat to my wife, sleeping together?" he asked.

The convoluted tale began in January, when an X-ray taken for an injury to the left side of his rib cage picked up a shadow in his right lung.
TB was immediately suspected, and eventually diagnosed. How he contracted the disease is not known, but a trip to Vietnam is a suspected source.

It was not until May 10 that doctors realized that Speaker's TB was resistant to several widely used drugs. They asked him not to travel, but did not discourage him from going to work or tell him to wear a mask and so he saw no reason not to stick with plans to get married in Greece.

Not until May 22 did health officials know that the resistance was even worse than they had thought. The bacteria were extensively drug resistant, or XDR, meaning that nearly all the usual TB drugs were useless. By that time, Speaker was already in Europe.

TB spreads through the air, but only a small percentage of people who are exposed to the bacteria actually get sick. XDR tuberculosis is not more virulent or more contagious than other types, but it is of great concern because it is so difficult to treat.

In Rome, Speaker was notified by the Centers for Disease Control and Prevention that he had XDR TB and should not fly. At first, he said, an official told him that the CDC would help him with travel plans. But a day later, he said, he was told that he would have to pay for a special medical evaluation that would probably cost $140,000 and that his name would be on a no-fly list. The official urged him to turn himself in to the Italian health authorities.

But Speaker said he believed that his best and perhaps only hope for a cure was to get to the National Jewish Medical and Research Center in Denver, which has expertise treating this kind of TB.

Fearing that he might be quarantined indefinitely in Italy, he and his wife, Sarah, avoided the no-fly list by booking a flight to Canada and then driving into the United States, where a border guard ignored an alert triggered by his passport. He said that he wanted to dispel the news media portrayal of him and his wife as "the super-rich, globe-trotting couple" who could easily have afforded to pay $140,000 to fly home in a private plane.

He said their wedding in Greece cost less than $2,000 and they had planned to travel around Europe afterward, staying in inexpensive hotels. He recently left his father's law firm to start one of his own and had sold his house and many of his belongings to finance it.

"The long and short of it is, we don't have $140,000" he said.

Beyond getting well, he said, his main concern is his law career and that is why he was speaking out. "When I'm done with all this, am I going to have a practice to get back to, with the impression out there now that I'm this selfish, self-absorbed person? It's not how I've lived my life. When I'm done with all this, I want to make sure I still have my life to get back to."


Source: http://www.iht.com/articles/2007/06/10/frontpage/health.php

Treatment Outcomes Of Patients With HIV And Tuberculosis

By, Medical News Today, June 7, 2007

In a retrospective study of 700 patients with culture-positive tuberculosis (TB), relapse rates were found to be significantly higher in HIV-infected patients compared to HIV-uninfected patients following a rifamycin-based regimen. Furthermore, TB relapse rates were higher in HIV-infected patients who received intermittent or standard 6-month therapy when compared to those receiving daily or longer treatment.

The results appear in the first issue for June 2007 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Payam Nahid, M.D., M.P.H., of the University of California, San Francisco General Hospital, and eight associates reviewed TB cases reported to the San Francisco Tuberculosis Control Program from January 1, 1990, through December 31, 2001.

As a rationale for their study, the researchers state that the optimal duration of TB therapy in HIV-infected subjects is unknown and may differ from HIV-uninfected individuals.

According to the authors, the current preferred regimen for treating drug-susceptible TB in HIV-uninfected patients is a 6-month, rifamycine-based regimen that includes pyrazinamide during the first two months. Current guidelines for the treatment of TB do not distinguish between those infected with the virus that causes AIDS and those who are uninfected in terms of the optimum length of treatment when using rifamycine.

"Standard 6-month therapy may be insufficient to prevent relapse in patients with HIV," said Dr. Nahid.

The TB relapse rate for HIV-infected patients was found to be 6.6 percent versus 0.8 percent in uninfected/unknown patients. This finding was in contrast to other studies that did not find any significant difference between HIV-infected and HIV-uninfected/unknown patients. However, this finding was corroborated by a similar study that also used molecular genotyping as a relapse indicator.

HIV-infected patients who received 6 months of rifamycin-based TB treatment or who were treated intermittently (one to three times per week), were four times more likely to have a reoccurrence than those r who took their medicine daily or who were treated for longer periods.

The study also found that the use of highly active antiretroviral therapy (HAART) during TB treatment was associated with a faster Mycobacterium tuberculosis negative culture conversion, and an improved survival rate. Prior studies by others have shown HAART treatment beneficial in preventing TB in HIV-infected individuals, but reported no beneficial TB treatment outcomes.

HIV-infected patients were significantly more likely to develop drug resistance (4.2 percent in HIV-infected versus 0.5 percent in HIV-uninfected) to rifampin , and to experience adverse reactions to TB regimens.

The investigators noted that there is a need for large randomized clinical trials to establish the optimal duration for TB therapy in HIV-infected patients, and the timing of HAART treatment in patients with HIV-related TB.

According to an editorial commenting on the research in the same issue of the journal, future HIV-related TB treatment regimens and relapse studies should broaden their focus to include rates of acquired drug resistance. The editorial cites a report published in the Lancet of an extensively drug resistant TB strain found in a HIV co-infected South African patient as particularly worrisome.

Citing the journal article, the editorialists also cast the HAART findings (quicker reduction of mycobacterial burden) as relevant in deterring TB drug resistance. They suggest that short-course, intermittent regimens may be necessary in areas where resources are limited, and that additional research on regimens (including the use of secondline drugs) suitable for field use must continue.

This news brief is based on an article published in the American Thoracic Society's peer-reviewed journal, the American Journal of Respiratory and Critical Care Medicine. www.ajrccm.atsjournals.org

Founded in 1905, the American Thoracic Society is the world's leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society has more than 18,000 members who prevent and fight respiratory disease around the globe, through research, education, patient care and advocacy.

http://www.thoracic.org

Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=72686&nfid=rssfeeds

TB complicates Aids treatment

By, SABC News, June 07, 2007

Scientists painted a bleak picture today of the combined risk of HIV/Aids and tuberculosis (TB) in South Africa. The third national Aids conference in Durban heard that new techniques are being developed to detect TB sooner, as many patients die before they receive treatment. Six out of 10 HIV positive patients are infected with the TB bacteria.

A patient can wait up to eight weeks for a sputum test result for TB. The long wait has put a strain on Aids treatment therapy. Many patients die during this time. There have been advances in other countries, but it is technology that will not be available in South Africa for a long time. In South Africa, multi-drug resistant TB (MDR TB) is on the increase, while the extreme form, XDR TB is leading to faster deaths.

About 250 000 South Africans are diagnosed with TB each year. The preventable and treatable disease, under control in most of the world, faces severe obstacles in Africa. The World Health Organisation warned today that it would take years before a TB vaccine or new TB drugs can be developed. Some experts advocated a combined treatment, which would require huge investment in African laboratories.

When it comes to a close tomorrow, the conference hopes to reach agreement on contentious issues of male circumcision, compulsory HIV testing and breast feeding.

HIV infections declining
Meanwhile, Manto Tshababalala-Msimang, the health minister, says there has been a statistically significant decrease in one of the key measures of HIV/Aids in South Africa. This follows the release of a health department report on the latest survey of HIV prevalence among pregnant women using public health facilities.

The report states that there has been a decline from 30.2% in 2005 to 29.1% last year.

It says this is the first evidence of a decline in the epidemic after several years of stable prevalence rates.


Source: http://www.sabcnews.com/south_africa/health/0,2172,150492,00.html

Dual TB, HIV treatment key to Aids battle

By, Mail & Guardian, Paul Simao, June 7, 2007

African, especially Southern African, nations must link tuberculosis (TB) testing and treatment with HIV-prevention programmes if they are to win the Aids battle, a top World Health Organisation (WHO) official said on Thursday.

Dr Kevin de Cock, head of WHO's HIV/Aids department, told the Third South African Aids Conference that traditional treatments for Africa's rampant TB problem could worsen the Aids pandemic and fuel the spread of the potentially fatal lung infection.

"TB programmes alone cannot reverse the tide," De Cock told about 4 000 Aids researchers, activists and healthcare officials at the conference in Durban.

He said it was vital to offer those infected with HIV and TB convenient and effective treatment for both diseases.

TB, which is spread through close personal contact, has long been a problem in Africa, where hundreds of millions are latent carriers of the disease. But the growing relationship between TB and HIV has made treatment of both diseases more difficult in vulnerable populations.

The emergence of extremely drug-resistant TB (XDR-TB), a strain virtually immune to traditional and modern antibiotics, has raised alarm bells since recently surfacing in South Africa's KwaZulu-Natal province and neighbouring Lesotho, where it killed up to 85% of those infected, the majority of whom also had HIV.

The strain has since spread to other parts of Africa as well as to the industrialised world, including the United States. The US government recently took the rare step of quarantining a man who had become infected with XDR-TB.

Two diseases interlinked
The prospect of a new and more virulent TB pandemic sweeping through sub-Saharan Africa is a far more serious threat because the two diseases are so prevalent and interlinked in the region.

In South Africa, 61% of the roughly 250 000 people diagnosed with TB each year have HIV.

HIV-positive people and others with weakened immune systems are particularly vulnerable to TB as well as other opportunistic infections. But XDR-TB has led to not only higher mortality rates, but also much faster deaths in HIV-positive populations.

In turn, HIV helps to spread TB in the general population. One of the paradoxes of the HIV pandemic is that the antiretroviral drugs that have saved so many lives contribute to a jump in TB because those who are co-infected are not being treated simultaneously for both diseases.

"HIV has caused a devastating reversal in our ability to treat TB," Robin Wood, director of South Africa's Desmond Tutu HIV Centre, said in a presentation to a Roche Diagnostics symposium on the sidelines of the conference. Wood said the solution was to combine treatments.

Doing so will require a huge investment in TB laboratories and related medical infrastructure in much of Africa as well as better tools to tackle the disease.

TB is still diagnosed using methods, such as skin tests, that can take days or even weeks to complete, while treatment can extend to months or sometimes more than a year, a challenge for Africa's often highly mobile population.

A urine-based dipstick test under development that gives results almost instantly could be the answer to beginning to tackle TB. "That would be a great asset if we could get it," Wood said. -- Reuters

Source: http://www.mg.co.za/articlePage.aspx?articleid=310629&area=/breaking_news/breaking_news__africa/

'Terrifying' memories of TB victim

By, Channel 4 News, June 5, 2007

A British victim of multi-drug resistant tuberculosis said that the plight of the US lawyer who has been isolated with a rare strain of the disease brought back "pretty terrifying memories".

Andrew Speaker, 31, of Atlanta, was found to have extensively drug-resistant tuberculosis, or XDR-TB, which can withstand more drugs, while travelling around Europe on his honeymoon last month.

Paul Thorn, who was diagnosed with multi-drug resistant TB 12 years ago, said news of Mr Speaker's plight brought back "terrifying memories" as the World Health Organisation (WHO) called for an extra 2.1 million US dollars (£1m) to fight the disease in America over the next two years.

Mr Thorn, 36, of London, said: "I've certainly lived a lot longer than I expected to."

The author and TB activist was diagnosed HIV positive in 1990 and was regularly admitted to hospitals in the UK as he became increasingly ill with aids-related infections in 1994 and 1995.

"It was on one of these visits to hospital that I was involved in an outbreak of multi-drug resistant tuberculosis," he said. "This happened on the ward essentially because of poor infection control. Eight of us were involved in the outbreak and seven people died. I'm the only survivor from that outbreak."

He said he spent three months in isolation before being deemed "non-contagious", when he was allowed to go home and take around 30 tablets-a-day, along with three injections per week, for the next three years.

"I've been watching American news channels at home in the UK and to see Andrew Speaker sat there in that mask brought back some pretty terrifying memories for me," he said. "Because for three months I was essentially cared for by people that I didn't know. I didn't know what they looked like. All I could ever see was their eyes. The disease itself, the weight loss was dramatic to say the least."

"Perhaps harder than the actual illness itself was the isolation and the way people reacted to me. Of course, I had a disease that people were very very frightened of. Tuberculosis is a very very lonely disease.

World-wide, around 424,000 people develop multi-drug resistant TB every year, the WHO said. XDR-TB was identified last year and has since been found in 37 countries on every continent, including all G8 nations.


Source: http://www.channel4.com/news/articles/society/health/terrifying+memories+of+tb+victim/547057

New TB vaccines could protect all strains

By, News-Medical.net, June 3, 2007

New tuberculosis (TB) vaccines in development have the potential to provide protection against all strains of TB, including multidrug-resistant (MDR) and extensively drug- resistant (XDR) TB, Dr. Jerald C.
Sadoff, president and CEO of the Aeras Global TB Vaccine Foundation, said at the International Conference on Global Health.

Aeras, the only non-profit organization dedicated solely to creating new TB vaccines, is working to develop at least one new TB vaccine regimen for infants and one for adolescents within seven to nine years and to ensure they are available worldwide to all who need them.

Aeras and its partners have the largest TB vaccine pipeline in the world with six vaccine candidates in or expected to be in Phase I-II trials in 2007.

Dr. Sadoff cited the rise of the new, deadlier strains of TB -- including MDR and XDR -- which are spreading around the world, including to the United States. This week the U.S. Centers for Disease Control and Prevention (CDC) quarantined a patient in Atlanta who is infected with XDR, and who had been traveling on transatlantic flights. XDR TB is resistant to many of the first and second line drugs, severely limiting treatment options. At least 37 nations have reported cases of XDR.

"TB is second only to HIV/AIDS as the world's most deadly infectious disease and is the leading cause of death among individuals infected with HIV. TB takes a victim every 20 seconds, which adds up to more than 1.5 million people every year," Dr. Sadoff said.

"The rise of MDR and XDR TB, which has a particularly high fatality rate in people with HIV, makes our mission even more critical. The vaccines under development by Aeras and its partners are intended to protect against all strains of TB and to be safe for use in people infected with HIV."

Dr. Sadoff noted that there has not been a new TB vaccine since the current vaccine, Bacille Calmette-Guerin (BCG), was developed more than 86 years ago. It provides some protection against severe forms of TB in children but is unreliable against pulmonary TB, which accounts for most TB worldwide.

"New vaccines, along with new drugs and diagnostics, are essential to the elimination of TB as a public health threat," he said. "The work that we are doing will help save millions of lives."

Aeras operates as a Product Development Partnership (PDP), developing candidate vaccines in its own laboratory and manufacturing facility and pursuing partnerships with public, private, academic and philanthropic sector organizations to promote rapid development and distribution of a more effective TB vaccine. It has a dual role -- to develop new vaccines and to ensure access to those around the world with the least ability to pay.

Aeras' largest source of funding is the Bill & Melinda Gates Foundation. It also receives support from the Dutch Ministry of Foreign Affairs, the Danish International Development Agency, and the U.S. Centers for Disease Control and Prevention.

This support has enabled Aeras to build a new facility in Rockville, MD, opened in 2006, that has the capacity to produce 150 million to 200 million vaccine doses a year of a modified BCG vaccine.

Despite the very generous contributions from the Gates Foundation and others, considerably more funding is needed to create a vaccine and bring it to market, Dr. Sadoff said.

The Global Plan to Stop TB puts the research and development costs of new vaccines, in 2006-20015, at $2.08 billion, with a current funding gap of $1.5 billion. The plan was created by the Stop TB Partnership, a network of more than 500 international organizations, countries, public and private sector donors, and nongovernmental and governmental organizations.

"We still need help from governments, foundations, other philanthropic organizations and the private sector to put a stop to this terrible disease," Dr. Sadoff said. "This is a global issue and it's going to require a global commitment to solve it."

Dr. Sadoff has worked in vaccine development for more than 30 years. He was involved in efforts to develop and obtain licensure for nine currently licensed vaccines and has been involved in the research and development of numerous other vaccines.

More information the work of the Aeras Global TB Vaccine Foundation is available at http://www.aeras.org/

Source: http://www.news-medical.net/?id=25876

The Deadly Intersection Between TB and HIV

By, WebMD, June 4, 2007

Tuberculosis (TB) is a disease that is spread from person-to-person through the air, and it is particularly dangerous for people infected with HIV. Worldwide, TB is the leading cause of death among people infected with HIV.

An estimated 10-15 million Americans are infected with TB bacteria, with the potential to develop active TB disease in the future. About 10 percent of these infected individuals will develop TB at some point in their lives. However, the risk of developing TB disease is much greater for those infected with HIV and living with AIDS. Because HIV infection so severely weakens the immune system, people dually infected with HIV and TB have a 100 times greater risk of developing active TB disease and becoming infectious compared to people not infected with HIV. CDC estimates that 10 to 15 percent of all TB cases and nearly 30 percent of cases among people ages 25 to 44 are occurring in HIV-infected individuals.

This high level of risk underscores the critical need for targeted TB screening and preventive treatment programs for HIV-infected people and those at greatest risk for HIV infection. All people infected with HIV should be tested for TB, and, if infected, complete preventive therapy as soon as possible to prevent TB disease.

Intersection of Two Global Epidemics
Approximately 2 billion people (one-third of the world's population) are infected with Mycobacterium tuberculosis, the cause of TB.
TB is the cause of death for one out of every three people with AIDS worldwide.
The spread of the HIV epidemic has significantly impacted the TB epidemic - one-third of the increase in TB cases over the last five years can be attributed to the HIV epidemic (Source: UNAIDS).
The Continued Threat of Multidrug-Resistant TB
Every nation must face the challenge of combating multidrug-resistant (MDR) TB. People infected with HIV and living with AIDS are at greater risk for developing MDR TB. MDR TB is extremely difficult to treat and can be fatal. While the number of cases has remained stable in the United States over the past few years, people with MDR TB have now been reported from 43 states and the District of Columbia.

To prevent the continued emergence of drug-resistant strains of TB, treatment for TB must be improved in the United States and across the globe. Inconsistent or partial treatment is the main cause of TB that is resistant to available drugs (MDR-TB.) The most effective strategy for ensuring completion of treatment is Directly Observed Therapy, and its use must be expanded.

Another challenge that individuals co-infected with HIV and TB face is the possible complications that can occur when taking HIV treatment regimens along with drugs commonly used to treat TB. Physicians prescribing these drugs must carefully consider all potential interactions.

Addressing the Dangers of the Interconnected TB/HIV Epidemics Requires Expanded Efforts
TB control is an exercise in vigilance; the goal of controlling and eventually eliminating TB requires a targeted and continuous effort to address the prevention and treatment needs for those most at risk, including HIV-infected individuals. Efforts to eliminate TB are therefore essential to reducing the global toll of HIV.

WebMD Public Information from the CDC

SOURCE: CDC: "The Deadly Intersection Between TB and HIV." http://www.cdc.gov/hiv/resources/factsheets/hivtb.htm


Source: http://www.webmd.com/hiv-aids/intersection-between-TB?src=RSS_PUBLIC