I’ve talked about multi-drug resistant tuberculosis on this site before, but I want to return to the topic because of some recent articles on the topic covered on NPR. Last year there was some good news about tuberculosis globally, as researchers found that the total number of cases was declining, particularly in China. A new national tuberculosis survey in China this year, however, reveals that 10% of all new cases of tuberculosis diagnosed that country are multi-drug resistant, while 8% of these cases were infected with XDR, or extensively drug resistant tuberculosis. For these people, the treatment options are limited, and may not be successful. The article in the New England Journal of Medicine described the problems within the Chinese health care system that are driving this problem. But these challenges sound very similar to difficulties in other nations, including India and South Africa
My previous work has been on HIV/AIDS, for which there is now a mood of optimism, given the new evidence that treatment is itself a form of prevention, because people receiving appropriate medications are much less likely to transmit the virus. For the first time, breakthroughs are being made in the immunology of the virus, which are so fundamental that they raise hopes that a vaccine may yet be possible. But even without a vaccine, we have the means available now to sharply reduce the number of infected, and to lessen the suffering of those people living with HIV.
While tuberculosis is a much older foe, it now seems more difficult to overcome. From the Canadian Arctic to South Asia the disease is making disturbing progress. As Richard Knox’s article on NPR noted, there is a new medication, delamanid, which may be available to treat tuberculosis in a few years. The good news was that that in one recent study this seemed to be a safe drug overall. Still, only 42% of the patients cleared the bacteria from their lungs on the medication. This is a major achievement, given that all of the patients were suffering from MDR tuberculosis. Delamanid also represents the first new class of drugs to treat tuberculosis in fifty years. But it still means that many people will need another treatment. There are other drugs in the research pipeline, including Bedaquiline, for which there are great hopes. Indeed, health experts and activists are currently lobbying the South African government to allow for the compassionate use of Bedaquiline in cases of XDR tuberculosis in that country. The TB alliance is playing a critical role in bringing new drugs to market, and it has a pipeline of new treatments moving forward. Still, tuberculosis does not receive the attention that a global threat of its magnitude deserves, and which is needed to create the same degree of progress as with HIV/AIDS.
Are you interested in global health? You might want to read my own book about the AIDS Pandemic in Latin America.
Shawn Smallman, Portland State University