H5N1

Uganda: Hospitals do not have TB drugs for children

Via New Vision: Hospitals do not have TB drugs for children. 

Medical experts have expressed concern over the reported lack of RHZ, a drug that is usuall given to children suffering from tuberculosis, in a number of hospitals. 

Dr. Fred Miti, the tuberculosis and leprosy supervisor at Mubende Hospital said the shortage has forced medical personnel to use adult drugs to treat the children. This, he said, puts children at the risk of going blind. 

Miti made the remarks on Tuesday during a tuberculosis/HIV policy dialogue meeting organised by the International Community of Women Living with HIV/AIDS.

Uganda: We should urgently integrate TB-HIV care

Via The Observer, an interview: We should urgently integrate TB-HIV care. Excerpt:

Tuberculosis (TB) is responsible for 60 percent of the deaths among persons living with HIV/AIDS. 

Given this relationship, the World Health Organization (WHO) recommends that care services are integrated between the two conditions. Uganda has registered some progress but the technocrats want the success rate at 100 percent. 

Kakaire Ayub Kirunda spoke to Dr Anna Nakanwagi Mukwaya, the Chief of Party in Uganda for the International Union against Tuberculosis and Lung Disease (The Union) to put things into perspective. 

Why is the integration of TB-HIV care such a big deal these days? 

HIV is the leading risk factor for the development of tuberculosis disease. At the same time, tuberculosis is the leading cause of death among people living with HIV. In a country like Uganda where the TB burden is so huge (the community has with TB germs in the air) and HIV/AIDS that is depressing the immunity of persons with HIV, then chances of picking TB are high. 

That is why you see this one AIDS patient with TB but usually the TB came because of the condition of HIV which affected their immunity. We can no longer have a situation where a patient comes into a clinic, gets treatment, and we do not look out for TB. It is going to kill them. Whenever health workers see HIV/AIDS patients, they have to look out for TB as well. 

And the day you confirm someone has TB, let them be advised to take an HIV test and if positive, start them on antiretroviral treatment because they will heal much faster than someone being treated for TB alone. If only one condition is treated, the patient may die along the way. If you somehow manage to treat the TB, they will get it again because the underlying problem is not being taken care of. The two diseases are no longer separable. 

The latest annual health sector performance report (AHSPR) shows that integration has improved tremendously but there are some academic works that paint a contrary picture. Why the discrepancy? 

You have to look at the statistics well. If I were at zero and I have moved to 10 or 20 percent of the performance, I have improved. But it doesn’t mean I have reached the optimum that is required. All TB patients are expected to be tested for HIV. So when we say integrate a service, we expect that every TB patient found in this country will receive an HIV test. 

So when you look at the AHSPR and last year they tell you they were at 60 percent but this year they are at 70 percent they will say they have improved but we want it at 100 percent.

Lesotho: High success rate in fighting MDR-TB in children

Via Partners in Health: PIH Achieves High Treatment Success Rate among Children with MDR-TB. Excerpt:

A recently published study in the scientific journal PLoS ONE shows that children being treated for multidrug-resistant tuberculosis (MDR-TB) in the small, mountainous country of Lesotho have achieved a treatment success rate of 88 percent–one of the highest in the world. 

Led by Dr. Hind Satti, country director for Partners In Health Lesotho (PIHL), the researchers reviewed the records of 19 children–ranging in age from 2 to 15–enrolled in the organization’s MDR-TB program between 2007 and 2011. 

Three-quarters of the children included in the study were also infected with HIV, and 63 percent were malnourished before starting treatment. Additionally, the mountainous terrain often made traveling to clinics difficult for patients and their families. 

However, the results from this study indicate that, as the authors write, “it is possible to achieve favorable outcomes … despite the geographically challenging setting and the high rate of baseline malnutrition, severe lung damage, and co-infection with HIV.” 

Of the 17 children for whom final outcomes were available, 15 of them had treatment success. Two of the patients, both of whom were also infected with HIV, died. None were lost to follow-up. 

Treatment success means either that the patient was cured, with five consecutive negative cultures, or had completed the full course of treatment and had no symptoms or evidence of TB.

Africa: Successful trial for new anti-TB drug regimen

Via allAfrica.com, a news release from TB Alliance: Trial Signals Major Milestone in Hunt for New TB Drugs. Excerpt:

A novel approach to discover the first new tuberculosis (TB) combination drug regimen cleared a major hurdle when Phase II clinical trial results found it could kill more than 99 percent of patients' TB bacteria within two weeks and could be more effective than existing treatments, according to a study published today in the Lancet. 

These results add to a growing body of evidence that the new regimen could reduce treatment by more than a year for some patients. 

The findings from researchers and the non-profit TB Alliance raise hope for a treatment breakthrough amid the growing and dangerous epidemic of drug-resistant forms of TB that, in some cases, are becoming untreatable. 

The results, presented today at the 2012 International AIDS Conference, also reveal progress in the pursuit of an antiretroviral-compatible TB treatment, which is critical to treating the millions of people with TB/HIV co-infection. 

Today, TB remains the largest killer of people with AIDS, but very often, TB and HIV treatments cannot be given together because of drug-drug interactions and side effects. 

The clinical trial tested a combination of one completely novel drug candidate, a new TB drug candidate already approved to treat other infectious diseases, and one existing TB drug. 

These results, along with pre-clinical data, suggest that this novel combination could treat both drug-susceptible and some forms of drug-resistant TB in only four months. Currently, people with multi-drug resistant TB (MDR-TB) require 18 to 24 months of treatment. Even those with ordinary TB need six months of taking drugs every day. 

"These findings confirm the promise of novel TB regimens to be shorter, simpler, safer, and, compared with today's MDR-TB drugs, much less expensive," said Mel Spigelman, MD, CEO and President of TB Alliance. 

"The next trial to advance this regimen is already underway. We now have real momentum toward bringing to market treatments that will ultimately help save millions of lives." 

TB Alliance's push to test new drugs in combination has been done to produce a regimen that not only would be faster and easier for patients, but also would tackle two other challenges as a major step in stopping the spread of drug-resistant TB--the complexity and high cost of treatment. 

This promising regimen eliminates the use of injectables and projects to reduce the cost of MDR-TB therapy by as much as 90 percent.

Cambodia: Is the outbreak a syndemic?

Via CNN.com: Mystery illness in Cambodia solved, doctors say. Click through for the full report and a video. Excerpt:

The cause of a mysterious illness that has claimed the lives of more than 60 Cambodian children has been determined, medical doctors familiar with the investigation told CNN on Wednesday. 

A combination of pathogens, disease-causing micro-organisms, is to blame for the illness, the World Health Organization, in conjunction with the Cambodian Ministry of Health, has concluded, the doctors said. 

The pathogens include enterovirus 71, which is known to cause neurological disease; streptococcus suis, which can cause infections like bacterial meningitis in people who have close contact with pigs or with pork products; and dengue, which is transmitted by mosquitoes. 

The inappropriate use of steroids, which can suppress the immune system, worsened the illness in a majority of the patients, the doctors said. The World Health Organization (WHO) is expected to advise health care workers to refrain from using steroids in patients with signs and symptoms of the infection, which include severe fever, encephalitis and breathing difficulties. 

While not all the microorganisms were present in each patient, doctors concluded the illness was caused by a combination of them and worsened by steroid use. 

The WHO sources did not want to be identified because the results of the health organization's investigation have not yet been made public. 

"I'm very confident for the reason of the epidemic," said Dr. Phillipe Buchy, chief of virology at the Institut Pasteur in Cambodia and one of the doctors who cracked the case. 

"The first thing that goes through your mind is, is this one of the usual suspects you haven't detected before?" said Dr. Arnaud Tarantola, chief of epidemiology and public health at the Institut Pasteur. "If it is, has it mutated, or changed in a way that it causes more severe disease? Or is it something completely new?" 

On the steroids issue, Tarantola said, "When you have a dying child, you try to use what you have at hand, and they were right to try that." But, he acknowledged, "from the cases we reviewed, almost all of the children died, and almost all of them had steroids."

I'll wait for the official announcement before rejoicing. But if this report is more or less accurate, Cambodia appears to have been dealing not with a single disease but with a syndemic—the spread of two or more diseases through a population, each disease making the others worse. 

Click through the link and you'll see that Wikipedia's definition emphasizes the origins of syndemics "under conditions of health disparity, caused by poverty, stress, or structural violence." This could explain a great deal about the impact of HIV and tuberculosis, for example. And it could explain the current ferocity of cholera in Haiti and many African countries.