NIAID
Research Priorities to Fight Drug-resistant Tuberculosis (TB)
In
certain areas of the world, tuberculosis (TB) is common in individuals who are
HIV positive, particularly in developing countries and among the homeless in industrialized
countries.
Tuberculosis has long been one of the world's great killers.
Now, forms of drug-resistant TB -- multidrug resistant (MDR) and extensively drug-resistant
(XDR) -- are occurring at an ominous and accelerating rate.
To
help in the fight against drug-resistant TB, the National Institute of Allergy
and Infectious Diseases (NIAID), part of the National Institutes of Health, has
formulated an MDR and XDR TB research agenda.
NIAID
director Anthony S. Fauci, MD
A
summary of the agenda, authored by NIAID director Anthony S. Fauci, MD, and members
of the NIAID Tuberculosis Working Group, is now available online in the Journal
of Infectious Diseases (April 21, 2008 advance edition).
"The TB diagnostic
tools in use today are antiquated, slow and insensitive; TB drug regimens are
complex and lengthy; and the only vaccine available does not provide effective
protection against adult pulmonary TB," said Dr. Fauci. "The challenge
of TB control is further compounded by the rise of drug-resistant TB, and we anticipate
that the NIAID Research Agenda for Multidrug-Resistant and Extensively Drug-Resistant
Tuberculosis will contribute substantively to the fight against this emerging
threat."
The World Health Organization (WHO) estimates that 500,000
people worldwide have MDR TB, while the frequently fatal XDR TB has been detected
in 46 countries. Factors contributing to the rising tide of drug-resistant TB
include:
•
Lack of routine
testing to determine TB drug-sensitivity;
•
Incomplete
treatment of people infected with TB-causing bacteria;
•
The epidemic
of TB in HIV-infected people;
•
Limited TB
research by pharmaceutical companies, resulting in few new anti-TB drugs or other
interventions.
The
NIAID research agenda complements domestic and international efforts to prevent
and control the spread of MDR and XDR TB. Whereas the WHO's STOP TB Partnership
plan emphasizes increased surveillance, control, and treatment efforts, the NIAID
agenda focuses on biomedical research. The Institute also collaborates with the
Centers for Disease Control and Prevention (CDC) and other NIH institutes and
centers on TB research efforts in the U.S.
To prevent the further emergence
and spread of MDR and XDR TB, the NIAID agenda identifies areas of biomedical
research that are likely to contribute substantially to a global public health
response. Building on existing efforts within the international network of TB
research, NIAID's priorities include efforts to:
•
Develop and
test reliable technologies to rapidly diagnose TB and to identify drug resistance;
•
Define the
most effective use of existing TB therapies and other antibiotics available to
treat drug-resistant TB and develop new drugs, particularly to treat MDR and XDR
TB;
•
Better understand
the basic biology of TB-causing bacteria and their interaction with the human
host that underlie the development of drug-resistant TB;
•
Understand
the epidemiology of drug-resistant TB;
•
Investigate
the various manifestations of TB in adults, children, and people with coinfections,
including HIV/AIDS;
•
Conduct research
to develop new vaccines and other preventive strategies.
NIAID
is leading and sponsoring research activities to create a foundation of knowledge
for the discovery of new diagnostics, drugs and vaccines. The Institute also supports
the efforts of organizations, such as drug companies and public-private partnerships,
to further develop these products into tools and approaches that enhance the quality
of care for people with TB.
"Only a concerted global effort can counteract
the rise of drug-resistant TB," Dr. Fauci noted. "Development of improved
diagnostics and better treatment and control strategies will depend on collaboration
with our partners at every research step, from basic science to large clinical
trials."
5/06/08 Reference
AS Fauci and the NIAID TB Working Group. Multidrug-resistant and extensively
drug-resistant tuberculosis: The National Institute of Allergy and Infectious
Diseases research agenda and recommendations for priority research. Journal
of Infectious Diseases. April 21, 2008 [Epub ahead of print].
