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Drug-resistant TB hindering efforts to fight disease

Estimated 1.7 million TB deaths a year and 9 million new cases worldwide

Adrian O'Dowd

Monday, 21 March 2011

Drug resistant tuberculosis (TB) is undermining efforts to fight the disease worldwide as levels of new cases have hit a record high, according to findings published in The Lancet.

In a seminar online first, the journal says that with increasing rates of drug-resistant TB, the progress being made for decades by world TB programmes is now under threat.

Smoking and diabetes are also fueling the global TB epidemic, says the report, written by Professor Alimuddin Zumla, University College London Medical School, and Dr Stephen Lawn, University of Cape Town, South Africa.

The authors said that TB resulted in an estimated 1.7 million deaths each year and the worldwide number of new cases (more than 9 million) was higher than at any other time in history.

They found that 22 low-income and middle-income countries accounted for more than 80% of the active cases in the world.

Sub-Saharan Africa has been disproportionately affected and accounted for four of every five cases of HIV-associated tuberculosis, due to the effect of HIV on susceptibility to TB.

“Increasing rates of drug-resistant TB in eastern Europe, Asia, and sub-Saharan Africa now threaten to undermine the gains made by worldwide tuberculosis control programmes,” the authors said.

In addition to the well known risk factors for developing contracting TB and developing full blown disease (such as HIV which increases risk more than 20-fold, poverty and over-crowding), the report lists other risk factors.

These included worldwide epidemic of diabetes and very high rates of tobacco consumption in low- and middle-income countries, which were now believed to be increasingly important drivers of the TB epidemic.

Diabetes increased the risk three-fold and smoking increased risk two-fold.

Many other risk factors included cancers (both solid and blood based), vitamin D deficiency, alcoholism, indoor air pollution, long-term kidney failure, genetic variations, and use of corticosteroids and tumour necrosis factor (TNF) drugs to treat conditions such as rheumatoid arthritis.

The authors concluded: “Absence of a cheap point of care diagnostic test, the long duration of treatment, lack of an effective vaccine, emergence of drug-resistant TB, and weak health systems in resource-poor developing countries are all factors that continue to hamper progress towards achieving control of TB worldwide.

“Despite this, there is growing momentum in basic and applied research activity that is starting to yield new diagnostic, treatment, and prevention methods, and now provide grounds for optimism.

“However, this growing scientific momentum must be matched by massive political and funder commitment to provide adequate funding to ensure that the aims of the WHO Global Plan to STOP TB 2006–15 are achieved.”

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