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Nov./Dec. 2009
Vol. 19 No. 11
Annual Meeting Coverage
New TB Drugs on the Horizon, But TB and HIV/AIDS Challenges Remain

The medical landscape for diagnosing and treating tuberculosis (TB) could change dramatically in the coming years, with new tests and better drugs paving an easier path for TB treatment and care, according to William Burman, MD, a TB specialist and a professor of medicine at the University of Colorado in Denver, who spoke at the 47th Annual Meeting of IDSA.

“We could have new TB drugs approved by 2011,” said Dr. Burman, a member of the Center for Global Health Policy’s Scientific Advisory Committee. Two drugs currently in the pipeline look particularly promising for TB treatment because they work in new ways and appear to be very potent. Those drugs and other research developments have the potential to “revolutionize the treatment of multidrug-resistant tuberculosis,” Dr. Burman said. “We can start to see the outlines of major improvement for TB treatment for patients,” with shorter and possibly safer therapy, too.

But the scope of the TB threat is still grave, he said, with 9 million new TB cases a year and more than 1 million deaths.  “The message is that this is a time of great need,” Dr. Burman said. “It’s also a time of great opportunity.”

At a symposium on HIV and TB, Richard Chaisson, MD, professor of medicine, epidemiology, and international health at Johns Hopkins University in Baltimore, detailed the “deadly synergy” between HIV/AIDS and TB, noting that TB incidence doubles in the first year following HIV seroconversion and that TB is associated with an increased risk of death in HIV-positive patients. Dr. Chaisson said better intensified case finding for TB is critical, along with better TB prevention and treatment strategies.

Another presenter, Gerald Friedland, MD, professor of medicine and epidemiology at Yale University in New Haven, Conn., described the current threat of drug-resistant TB. He said the extent of multidrug-resistant and extensively-drug resistant TB is unknown because of poor diagnostic capabilities, and he highlighted the need to provide community-based treatment of drug-resistant TB to reduce transmission and reduce high rates of mortality.

In a symposium on HIV in the developing world, Eric Goosby, MD, the U.S. global AIDS coordinator, described efforts to transform PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief, from an emergency response initiative to one that focuses on building sustainability and country ownership. Dr. Goosby also outlined the administration’s focus on strengthening health systems and how HIV/AIDS fits into the plans for a new six-year $63 billion Global Health Initiative. The economic crisis made robust scale up of PEPFAR funding “impossible,” said Dr. Goosby, who spoke of the need to engage key U.S. allies for a more collaborative international effort against global AIDS.

Two other HIV/AIDS experts said the gains made in the last decade against this deadly pandemic are tenuous, and developing countries could all too easily lose ground if leadership and resources wane. “We’ve progressed from a situation of calamitous magnitude to one that’s extremely serious,” said Mark Cotton, MD, a professor of medicine at Stellenbosch University in South Africa. “And that progress is very fragile.”

Dr. Cotton, a pediatrician, detailed the difficulties of treating HIV in infants and children. Many South African physicians and nurses are afraid to do it, he said, because of the complexities of diagnosis and the lack of appropriate drug formulations for children. Some key antiretroviral drugs are not well tolerated by children due to their bad taste combined with an inability to substitute due to a lack of alternatives. Researchers need to focus urgent attention on developing new drugs and easier formulations for children, he said.

Another South African HIV specialist, Quarraisha Abdool Karim, MD, with the Centre for the AIDS Programme of Research in South Africa, discussed the difficulties in HIV prevention efforts, particularly among women. She said there is no magic bullet, and physicians must rely on combination strategies to curb the pandemic.

Audio and synchronized speaker slides from sessions at the 2009 IDSA Annual Meeting are available for purchase online.
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