New York Times Editorial - Extreme tuberculosis
New York Times Editorial - Extreme tuberculosis
Copyright by The New York Times
Published: September 14, 2006
Tuberculosis is outrunning us. In the last few months, 53 patients in the South African province of KwaZulu-Natal were found to have a form of the disease resistant to enough existing drugs that it is virtually incurable. All but one of those patients have died. Airborne and deadly, extensively drug-resistant TB is a nightmare disease. It has been found worldwide, including in the United States.
The accelerated pace of resistance comes from the world's neglect of tuberculosis, which is best cured with a cocktail of four drugs, with medicines taken daily for six to nine months. But most patients who start this difficult regime fail to complete it, leading to resistance. Of the 9.5 million new TB cases globally every year, about 425,000 of them are resistant to the standard medicines.
While a course of standard drugs costs as little as $11, the medicines needed to cure resistant TB can cost up to a thousand times as much, can have harmful side effects, and must be taken for as much as two years. The really bad news, however, is that even these backup drugs are starting to fail, as they have in KwaZulu-Natal. Globally, about 6 percent of resistant TB cases are also resistant to second-line drugs - 15 percent in the former Soviet Union.
The development of antibiotics had allowed wealthy nations to dismiss TB as a disease of the past. But HIV and AIDS have changed that calculus. In Africa, active TB cases are rising by 4 percent a year, largely because HIV activates latent TB infection. TB is the leading cause of AIDS-related deaths. Every patient tested in the KwaZulu-Natal study was HIV-positive - and more than a quarter of those who died were taking antiretroviral therapy.
African health officials gathered in South Africa last week to discuss extreme tuberculosis, but they are hobbled by the world's indifference. New drugs are needed to replace current ones, which are all at least 40 years old. But TB drug research had dried up until a few years ago.
A treatment for extremely resistant TB is not likely before 2012. Money for clinical trials would speed things. But donors have always slighted tuberculosis. Stinginess created this problem. Generosity is needed to fix it.
Copyright by The New York Times
Published: September 14, 2006
Tuberculosis is outrunning us. In the last few months, 53 patients in the South African province of KwaZulu-Natal were found to have a form of the disease resistant to enough existing drugs that it is virtually incurable. All but one of those patients have died. Airborne and deadly, extensively drug-resistant TB is a nightmare disease. It has been found worldwide, including in the United States.
The accelerated pace of resistance comes from the world's neglect of tuberculosis, which is best cured with a cocktail of four drugs, with medicines taken daily for six to nine months. But most patients who start this difficult regime fail to complete it, leading to resistance. Of the 9.5 million new TB cases globally every year, about 425,000 of them are resistant to the standard medicines.
While a course of standard drugs costs as little as $11, the medicines needed to cure resistant TB can cost up to a thousand times as much, can have harmful side effects, and must be taken for as much as two years. The really bad news, however, is that even these backup drugs are starting to fail, as they have in KwaZulu-Natal. Globally, about 6 percent of resistant TB cases are also resistant to second-line drugs - 15 percent in the former Soviet Union.
The development of antibiotics had allowed wealthy nations to dismiss TB as a disease of the past. But HIV and AIDS have changed that calculus. In Africa, active TB cases are rising by 4 percent a year, largely because HIV activates latent TB infection. TB is the leading cause of AIDS-related deaths. Every patient tested in the KwaZulu-Natal study was HIV-positive - and more than a quarter of those who died were taking antiretroviral therapy.
African health officials gathered in South Africa last week to discuss extreme tuberculosis, but they are hobbled by the world's indifference. New drugs are needed to replace current ones, which are all at least 40 years old. But TB drug research had dried up until a few years ago.
A treatment for extremely resistant TB is not likely before 2012. Money for clinical trials would speed things. But donors have always slighted tuberculosis. Stinginess created this problem. Generosity is needed to fix it.
posted by Carlos T Mock @ 9:52 AM
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