The rise in incidence of multidrug resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis is of critical concern. Patients with MDR-TB may require more than 2 years of treatment, which can be extremely costly and particularly difficult in resource-limited settings—especially because the side effects of treatment can be severe. XDR-TB is even more difficult to treat, and for some patients, no effective drugs are available. NIAID contributes to the National Action Plan for Combating MDR-TB through its support of research into new diagnostics, as well as antibiotics and other therapies to combat the growing problem of MDR-TB and XDR-TB. For instance, trials being run through some of the programs in NIAID’s HIV/AIDS Clinical Trials Networks will test the efficacyof the drug bedaquiline against MDR-TB. In a separate trial , a combination therapy using both bedaquiline and delamanid will also be tested against MDR-TB.
In collaboration with research institutions and international organizations, NIAID continues to support advances in TB product development. In June 2016, a NIAID-hosted conference titled “New Approaches to Combating Tuberculosis: Leveraging NIH Intramural TB Research for the Global Effort,” brought together researchers from various institutions throughout the world to discuss ongoing efforts and collaborations. NIAID also co-hosted two workshops on new drugs with the Stop TB Partnership in 2016.
As part of NIAID’s focus on improving TB treatment, we also are investigating supportive approaches to help patients during the treatment of their disease. For example, some TB drug regimens require such strict adherence that patients must be observed by a health care professional as they take their daily medication. This is a costly and time-consuming precaution necessary to ensure full recovery and prevent complications. Recently, NIAID-supported trialsbegan to investigate whether mobile technology could replace the need for more frequent in-home visits by health care professionals. Other programs administered through the HIV/AIDS Clinical Trials Networks are researching how to prevent an infection with MDR-TB after close exposure to a case, and whether a 1-month regimen could be effective at preventing TB infection.
Detecting infection early is key to minimizing suffering caused by TB, and NIAID is working to develop and refine diagnostic tools for TB. In this regard, we contribute to global consortia that are mapping the genetic diversity of MDR or XDR strains of Mycobacterium tuberculosis. NIAID’s Tuberculosis Research Units Network program has helped identify biomarkers that define the various stages of infection. International collaboration is key to establishing clinical research capabilities and patient cohorts, which will facilitate future research into the clinical and pathologic characteristics and spread of different TB strains in India, Brazil, Indonesia, South Africa, and other parts of the world.
The World Health Organization estimates that 43 million lives were saved between 2000 and 2014 as a result of improved diagnosis and treatment of TB. Sustained biomedical research is key to continuing to advance medical countermeasures against TB. Through ongoing and future research initiatives, and collaboration with other funding agencies and organizations, NIAID is dedicated to saving and improving the lives of people with TB.
Anthony S. Fauci, M.D., is Director of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health in Bethesda, Maryland. Richard Hafner, M.D., is chief of the TB Clinical Research Branch in the NIAID Division of AIDS; Christine F. Sizemore, Ph.D., is chief of the Tuberculosis and other Mycobacterial Diseases Section in the NIAID Division of Microbiology and Infectious Diseases.
This post is part of the ‘Tuberculosis Today’ series produced by The Huffington Post highlighting the challenges of combatting TB. Tuberculosis is now back in the top ten causes of death globally, and it is the world’s leading infectious disease killer despite being curable and preventable.