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The international medical aid organisation Medecins sans Frontieres (MSF) on Tuesday backed calls for a new approach to the treatment of deadly drug-resistant tuberculosis, which is spreading rapidly among HIV patients in Sub-Saharan Africa.
The changes should include an end to isolating TB patients in hospital wards for long periods of time - a practice MSF called counter-productive. Instead, they could be treated in their communities with individualised plans of treatment, MSF said.</o:p>
MSF was repeating its past calls for an end to the isolation ward treatment, a policy blamed for violent rioting by patients at a TB hospital in Gauteng province last week.</o:p>
"The reality is exploding in our faces," said Dr Eric Goemaere, MSF's head of mission in the sprawling Khayelitsha township outside Cape Town.</o:p>
'The reality is exploding in our faces'</o:p>
He was referring to the high prevalence of drug-resistant TB in South Africa, the country with the largest number of HIV infections.</o:p>
TB is most frequent cause of death among the estimated 24,7 million people with HIV in Sub-Saharan Africa.</o:p>
Multi-drug-resistant TB (MDR-TB) occurs in patients that are resistant to the two most powerful first-line TB antibiotics. These patients have a less-than-50-per-cent chance of survival.</o:p>
Poor TB control programmes - including patients' not finishing their treatment - are usually blamed for the development of drug-resistance. But over the past two years, 30 per cent of more than 200 patients who developed drug-resistant TB in Khayelitsha had never had TB before, Goemaere noted.</o:p>
One in 10 MDR-TB patients goes on to develop resistance to two classes of second-line drugs, and becomes ill with a form of the disease called extensively-drug-resistant TB (XDR-TB), which is almost impossible to treat.</o:p>
About one in five South Africans is HIV-positive</o:p>
Drug-resistant TB has been around since the 1940s but is aggravated in countries with a high HIV prevalence, according to Harvard Medical School's Carole Mitnick.</o:p>
The World Health Organisation estimates the number of new drug- resistant TB cases at 450 000 each year. South Africa, where around one in five adults is HIV-positive, has about 6 000 new MDR-TB cases per year.</o:p>
MSF backed calls from Mitnick and other US experts in a report in Tuesday's edition of PLoS Medicine for MDR-TB patients to be included in clinical trials of new TB drugs. The magazine is available online as an open-source medical journal.</o:p>
"This is quite simply the best hope we have of getting improved medicines to patients with multi-drug-resistant TB faster," Goemaere said. "We cannot afford to wait."</o:p>
Until now donors had been focusing on the long-term goal of a complete new first-line treatment for both drug-resistant and normal TB, said Dr Tido von Schoen-Angerer, head of MSF's Access to Essential Medicines Campaign. This would likely take another decade or two.</o:p>
In the meantime, new trials were needed to achieve "some improvement in the desperate situation for MDR-TB treatment" by determining individualised treatment regimens for each patient.</o:p>
Contrary to the belief that isolation was necessary to prevent the spread of the infection, it was "probably the worst strategy", except in extreme cases, said Goemaere.</o:p>
A recent report in the British medical journal Lancet showed that the first outbreak of XDR-TB in South Africa in 2005/2006, which claimed the lives of 52 out of 53 patients, was driven by infections that occur in hospitals, he pointed out.</o:p>
Delays in diagnosis and obtaining a hospital bed also meant that MDR and XDR-TB patients had plenty of time to infect others before being isolated.</o:p>
In addition, patients were stigmatised because they spent two years in isolation. They suffered from side-effects such as deafness, kidney problems and severe nausea, from the medicine, leading to a total breakdown in understanding between doctors and patients, he said.</o:p>
MSF repeated its past calls for a strategy that would allow TB patients to remain within their community by developing infection control mechanisms, schooling people in cough etiquette and improving ventilation in clinics and minibus taxis.</o:p>
The run-up to the 38th Union World Conference on Lung Health in Cape Town on November 8-12 has been marked by a raft of position papers on TB and HIV/TB co-infection from health experts and NGOs.</o:p>
Around 3 000 delegates are expected at the conference, which will hear calls for a new, combined approach to the HIV/TB co-epidemic, including the need for a TB vaccine, new drugs and diagnostic tools.</o:p>
The experts writing in PLoS Medicine also called for improved funding for TB research, particularly new drug development, and towards building capacity for countries with a high TB burden to hold clinical trials. - Sapa-DPA.</o:p>
