March 24, 2005
Christine F. Sizemore, Ph.D., Barbara E. Laughon, Ph.D. and
Anthony S. Fauci, M.D.
National Institute of Allergy and Infectious Diseases
National Institutes of Health
The commemoration of World TB Day 2005 serves as a grim reminder that tuberculosis (TB), a deadly disease that has affected humankind for thousands of years, is still a serious public health threat. Despite global TB control efforts, the availability of drugs to cure TB and a vaccine that reduces the impact of the disease on young children, TB continues to exact a staggering toll: more than 2 million deaths worldwide each year.
The past several years have been marked by significant progress in understanding how the microbe Mycobacterium tuberculosis interacts with its host to cause TB. Insights gleaned from basic research studies are being used to develop new strategies and products to detect, prevent and treat this devastating disease. Through the collaborative efforts of the National Institute of Allergy and Infectious Diseases (NIAID) and other government agencies, academic institutions, and public/private partnerships, several promising new TB drugs and vaccines are being evaluated in clinical trials or are being prepared for such testing. For example, the Global Alliance for TB Drug Development and NIAID have been working together to advance a promising new drug candidate, called PA-824, for human testing later this year. Several other promising new drug and vaccine candidates are now poised for clinical trials, the first such efforts in more than four decades. Considering that significant translational research has been underway for less than a decade, the advancement of new vaccine and drug products in the past few years is an extraordinary achievement.
Progress is being made, but daunting challenges remain. The World Health Organization (WHO) and other agencies continue to report the rapid spread of multi-drug resistant TB (MDR-TB), a serious emerging public health threat with the potential to push TB care back into the pre-antibiotic era. Antibiotics that have been the staple of TB care for many decades are slowly losing their effectiveness, and second-line therapies are often too difficult to take, not available, or too expensive to be widely implemented in countries with the highest burden of MDR-TB.
We also face the sobering reality that TB will not be effectively controlled unless another global scourge, HIV/AIDS, is curbed. Globally, TB is the primary cause of death in HIV-infected people. In regions with a high burden of both diseases, healthcare clinics are overwhelmed with patients carrying both M. tuberculosis and HIV. Each of the two infections has a negative impact on the other. Furthermore, anti-TB and anti-HIV medications are not always compatible, and when taken together may adversely impact each others' safety and effectiveness.
NIAID supports a robust portfolio of research to develop new drugs and diagnostics, to evaluate improved therapeutic regimens, and to test vaccines to prevent TB infection. Concomitantly, programs such as WHO's Directly Observed Treatment, Short-Course (DOTS) strategy; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and President Bush's Emergency Plan for AIDS Relief (PEPFAR) are having an enormous impact in the fight against both TB and HIV/AIDS. Collaborations between these and other programs are providing treatment and care for patients and communities affected by both diseases. As we move forward, fundamental, translational and clinical science in TB and HIV/AIDS must be coordinated to expedite progress and make the best use of available resources. NIAID is encouraging scientists to consider their research and development efforts in light of both HIV/AIDS and TB, to better understand how the diseases influence each other and how we can tailor interventions to function in the reality of TB/HIV co-infections.
Researchers are developing vaccine candidates and strategies that may provide protection against TB for persons with compromised immune status. Drug candidates targeted against M. tuberculosis are being selected to be compatible with antiretroviral therapies. Diagnostic tests are being developed that will be able to identify or rule out the M. tuberculosis infections that frequently occur outside the lung in AIDS patients.
NIAID is firmly committed to supporting TB research for the "real world," which sadly includes the millions of TB patients globally who are co-infected with HIV. The fields of HIV/AIDS and TB research are converging, as scientists and policymakers realize that these diseases cannot be investigated separately. Synergistic research in the two fields promises to yield new interventions that joint TB/HIV care programs can use to reduce the burden of both diseases in the 21st century.
Anthony S. Fauci, M.D., is Director of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health. Christine F. Sizemore, Ph.D., is Acting Chief of the Tuberculosis and Other Mycobacterial Diseases Section in the NIAID Division of Microbiology and Infectious Diseases. Barbara E. Laughon, Ph.D., is Chief of the Complications and Co-Infections Research Branch of the Therapeutics Research Program in the NIAID Division of AIDS.
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Last Updated March 24, 2005