Ten million people around the world became sick with tuberculosis (TB) in 2017. The World Health Organization calls it "the world's deadliest curable disease".
According to the U.S. Centers for Disease Control and Prevention, 1.3 million people died that year of TB-related illness. But how often do you read and hear about the problem?
Although TB affects people of differing health status, people living with HIV are particularly vulnerable. And until now, there has been no safe, effective TB prevention therapy for those patients who are being treated for HIV. An study to test a combined therapy was halted early due to severe patient reaction.
Now, there is new hope.
A game changer
A study presented today has found that a three-month course of drugs to prevent tuberculosis is effective and can safely be given to people who are taking the first-line medicines for HIV. The pan-African, South Africa-based Aurum Institute released the findings at the Conference on Retroviruses and Opportunistic Infections (Croi) convened in Seattle in the American state of Washington. Aurum is a respected healthcare organization – a not-for-profit – that has been battling "the joint scourge of HIV and TB for over 20 years".
Professor Gavin Churchyard of South Africa, who co-led the study, said in an interview that because the preventive therapy is shorter than in earlier trials, "It is safer, it is more tolerable, and it is associated with better adherence and treatment completion." In other words, more people can tolerate it, and it works.
The study was conducted in 12 high-burden countries – those with high rates of both HIV and TB – eight of them in sub-Saharan Africa: Ghana, Ethiopia, Kenya, Tanzania, Malawi, Zimbabwe, Mozambique and South Africa. Churchyard said the researchers will collaborate with WHO and the project countries so that the findings can be included, as quickly as possible, in new treatment guidelines.
Churchyard describes the new research results as "incredibly reassuring". The regimen is safe, and we don't need to change the dose of dolutegravir" – the current standard of HIV treatment in high-burden countries. "So this now becomes a game changer for people living with HIV. We have a short regimen that they can use safely while on antiretroviral therapy, and there are higher treatment completion rates."
In a statement about the results, the Aurum Institute and the study collaborators said that global heads of state meeting in New York in September 2018, committed their countries to providing preventive TB treatment to at least 30 million people, including six million people living with HIV by 2022.
"In order to end TB, we need to prevent TB, Churchyard said in the interview. "We call on all countries to honor their commitments made at the UN high-level meeting to scale up TB preventive therapy as one of the key interventions to end the TB epidemic." He said the next step is enrolling up to 600 thousand people in the 12 study countries, which should prompt an increase in demand and supply – and to negotiate for lower drug prices to make a scale-up of prevention possible.
If the world truly wants "to eliminate TB as a global health risk, prevention becomes increasingly important" Churchyard said, pointing out that high-income countries such as the United States, Canada and other economically developed nations are not immune to the deadly disease. "They, too, have to really focus on preventing TB, including among household members of patients – especially vulnerable children. It's of global importance."