Shobha Shukla - CNS
Dr Susan Swindells of UNMC (left) and Shobha Shukla of CNS (right)
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When tuberculosis (TB) is preventable and curable, is it not shocking that it still remains the biggest-killer-infectious-disease worldwide? According to the latest WHO Global TB Report 2019, 1.5 million people died of TB last year, and between 1.5 to 2 billion people are infected with latent TB. Only a very small part of this latent TB infected population will progress to active TB disease. Latent TB infection is also preventable and treatable, significantly reducing risk of progressing to active TB disease. But the grim reality is that progress on addressing latent TB pool is dismal.
"TB is a disease that can be prevented and treated. So there is not much excuse, as we can do much better. We know that TB preventive therapy is effective, and is also effective in people living with HIV, but the uptake globally is very poor. Very few people with HIV (who are at greater risk of progressing from latent TB to active TB disease), are offered TB preventive therapy" said Dr Susan Swindells, Professor, Department of Internal Medicine, and Medical Director, Speciality Care Clinic, University of Nebraska Medical Center in USA. She spoke with CNS (Citizen News Service) at the 12th National Conference of AIDS Society of India (ASICON 2019) in Chennai, India.
Dr Susan Swindells, who is a senior scientist on HIV and TB (and latent TB), reflects on reasons for poor uptake of TB preventive therapy. "Reasons for that are several. First of all, conventional TB prevention therapy takes a long time. It is at least 6 or 9 months. TB treatments have side effects. TB drugs have not developed as quickly as drugs for HIV. Now we have HIV drugs that are very potent and work extremely well with basically no side effects, but for TB we are still dealing with drugs that have side effects."
Healthcare providers need to rule out active TB disease before starting TB preventive therapy. But diagnosing active TB disease could be challenging at times, such as in some people living with HIV. This is also one deterrent for healthcare providers that dissuades them from offering TB preventive therapy without knowing for sure that the person has no active TB disease. But it is becoming easier now to exclude active TB disease with new and more specific and sensitive diagnostic tools, and increasing availability and accessiblity of such tools in high burden nations.
Shorter one-month TB preventive therapy gives hope
"There is so much priority on giving antiretroiral therapy to people living with HIV that TB preventive therapy often gets forgotten. I think we have some exciting opportunities now we have new shorter courses for treatment to prevent TB that are as good, if not better, than the standard six months of isoniazid. Four months of rifampin works well, weekly isoniazid and rifampin for three months works very well, and study I co-chaired that was recently published, show, that one-month of daily isoniazid and rifapentine works well too" said Dr Swindells.
"The beauty of one month TB preventive treatment is that completion rates (number of people that completed the treatment) is the highest that is ever seen because taking treatment for a month is possible for most people than longer duration therapies for six months. Because one month was short there were fewer side effects and this one-month therapy for TB prevention was as effective as longer duration therapies. So we are excited that the WHO is looking at including this in their guidelines, and we hope there will be greater uptake of this one month TB preventive therapy in many countries globally, including in India" said Dr Swindells.