Sunday November 17, 2019

Tuberculosis not a Life-long Infection in Most People, Says Study

The study was published in the British Medical Journal (BMJ)

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TB
A tuberculosis patient holds medicines at the Lal Bahadur Shastri Government Hospital at Ram Nagar in Varanasi, India, March 13, 2018. VOA

Researchers have found that people who test positive with immunologic tuberculosis (TB) skin or blood tests rarely develop the disease.

It is because the infecting organism, Mycobacterium tuberculosis, is likely dead, wiped out naturally by people’s immune systems, a new study suggests.

“The National Institutes of Health and other nonprofit organizations spend millions of dollars on studies of the latent state because of the assumption that TB infection is life-long, held in check by the immune system,” said study co-author Paul H. Edelstein from the University of Pennsylvania.

However, based on our analysis, we believe that it is rarely life-long, and in 90 per cent or more of infected people, there is no possibility of TB development even with severe immunosuppression,” Edelstein said.

In their review, the team pointed to several previous studies to demonstrate the natural history of TB immunoreactivity in people given preventive treatment, and of active TB in immunoreactive people with various forms of severe immunosuppression, like patients with HIV and those who have received an organ transplant.

One study showed that the treatment of people with TB immunoreactivity for one year lowered the incidence of active TB by 60 to 70 per cent over the next nine years.

Tuberculosis
FILE – A tuberculosis patient receives treatment at a clinic in Jakarta, Indonesia. VOA

Yet, those treated remained skin test positive for TB up to nine years later, showing TB immunoreactivity can outlast elimination of infection by at least nine years.

In another study, of patients co-infected with HIV and TB–who are at a higher risk for active TB–researchers showed that between 89 per cent and 97.5 per cent of those with positive TB immunoreactivity tests remained free of TB from their remote infection over a five-year period.

And in the third study of stem cell transplant patients, none of the 29 participants from the US cohort with TB immunoreactivity developed TB after a total of 89 person-years of observation.

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“TB immunoreactivity is not a marker for the presence of continued TB infection, rather, it serves as a sign of having been infected with TB at some point,” Edelstein said.

“We need to put more effort into controlling active TB and to determine how to detect the 10 per cent of people who actually do have a lifelong infection,” he added.

The study was published in the British Medical Journal (BMJ). (IANS)

Next Story

New Tuberculosis Treatment for 150 Countries Including India and South Africa to Cost $1,040

BPaL is an oral treatment which promises a shorter, more convenient option to existing TB treatment options, which use a cocktail of antibiotic drugs

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Tuberculosis, Treatment, Countries
A tuberculosis patient receives treatment at the TB Hospital in Gauhati, India, March 24, 2012. VOA

A newly approved three-drug treatment for tuberculosis will be available in 150 countries including India and South Africa, priced at $1,040 for a complete regimen, more than twice the cost proposed in the past by advocacy groups for other treatments.

The United Nations-backed Stop TB Partnership said on Monday that BPaL would be obtainable in eligible countries through the Global Drug Facility (GDF), a global provider of TB medicines created in 2001 to negotiate lower prices for treatments.

Tuberculosis was responsible for 1.5 million deaths in 2018.

BPaL is an oral treatment which promises a shorter, more convenient option to existing TB treatment options, which use a cocktail of antibiotic drugs over a period of up to two years.

Tuberculosis, Treatment, Countries
The United Nations-backed Stop TB Partnership said on Monday that BPaL would be obtainable in eligible countries through the Global Drug Facility (GDF), a global provider. Pixabay

The new cocktail, which will treat extensively drug-resistant strains of the illness, consists of drug developer TB Alliance’s newly-approved medicine pretomanid, in combination with linezolid and Johnson & Johnson’s bedaquiline.

Pretomanid, which will be available at $364 per treatment course, is only the third new medicine for drug-resistant tuberculosis to be approved in about 40 years, after J&J’s bedaquiline and Otsuka Pharmaceutical Co Ltd’s delamanid.

Criticism

Advocacy groups have long criticized the cost for bedaquiline and delamanid. Not-for-profit Medecins Sans Frontieres (MSF) has waged a running battle in public with J&J over its $400 price tag for a six-month course for bedaquiline.

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MSF has argued that bedaquiline could be produced and sold at a profit for 25 cents per day, and that the price of treatments for drug-resistant TB should be no higher than $500 for a complete treatment course.

Leena Menghaney, the South-Asia head for MSF’s Access Campaign, said it was a cause of concern that pretomanid was priced just below the price of bedaquiline.

But Stop TB Partnership says costs of other regimens for extremely drug-resistant TB range from $2,000 to $8,000 — for courses of at least 20 months.

Drugmakers

Tuberculosis, Treatment, Countries
Tuberculosis was responsible for 1.5 million deaths in 2018. Pixabay

TB Alliance in April granted a license to U.S. drugmaker Mylan NV to manufacture and sell pretomanid as part of certain regimens in high-income markets, as well as a non-exclusive license for low-income and middle-income countries, where most tuberculosis cases occur.

Stop TB Partnership said it would start supplying the regimen following World Health Organization’s guidance on using the drug. Mylan, however, said it will also sell the drug directly to countries.

Prices in low-income countries would be in-line with the price offered through GDF, but would be decided on a case by case basis where the drug is not supplied through GDF, it said.

The drug will be available in bottles of 26 tablets, with a six-month treatment requiring seven bottles.

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India-based Macleods Pharmaceuticals Ltd has also been granted a non-exclusive license to make pretomanid as part of the BPaL regimen, TB Alliance said Monday.

The maker of generic drugs will market the treatment in about 140 countries with high tuberculosis rates. (VOA)