Tuberculosis

10. Shorter Tuberculosis Prevention and Treatment

Studies presented this year showed that a 9-month treatment regimen cured more than 80% of people with multidrug-resistant tuberculosis (MDR-TB) in an observational study in Africa, while a 3-month regimen of isoniazid and pyrazinamide was as effective as 6 months of isoniazid alone at preventing the development of active tuberculosis disease in people with HIV.

At the Union World Conference on Lung Health in December researchers reported findings from a study testingtreatment for people with rifampicin-resistant TB using kanamycin, moxifloxacin, prothionamide, isoniazid, clofazamine, ethambutol, and pyrazinamide for 4 months, followed by moxifloxacin, clofazamine, ethambutol, and pyrazinamide for 5 months. The overall cure rate was 82%; however, people with high-level resistance to fluoroquinilones or isoniazid were less likely to be cured.

Another study called STREAM is now testing 6- and 9-month MDR-TB treatment regimens containing the newer drug bedaquiline (approved in 2013).

For drug susceptible TB, researchers reported in March that an oral regimen of pretomanid (PA-824), moxifloxacin, and pyrazinamide -- a combination dubbed PaMZ -- taken for 8 weeks eliminated more TB bacteria from sputum and did so faster than standard therapy using isoniazid, rifampicin, pyrazinamide, and ethambutol. This regimen in now in Phase 3 trials.

Researchers reported at the Conference on Retroviruses and Opportunistic Infections in February that a combination regimen containing high-dose rifampicin plus isoniazid and pyrazinamide led to faster TB bacteria culture conversion than standard therapy, though adding moxifloxacin or the experimental drug SQ109 showed no additional benefit.

Finally, a presentation at the European AIDS Conference in October showed that a daily 3-month regimen of isoniazid plus pyrazinamide was as effective as isoniazid monotherapy for 6 months in preventing TB infection from progressing to active TB disease.

Taken together, these studies offer hope of faster, easier, and more effective therapy for TB, which remains a leading killer of people with HIV worldwide.

FIRST: 1. Treat Everyone Living with HIV