Expand TB Prevention and Care, U.N. Forum Urges
By Michael Smith
NEW YORK, 10 june 2008-- Tuberculosis treatment, prevention, and research needs to be scaled up drastically in conjunction with the battle against HIV/AIDS, speakers at a United Nations forum said today.
In a call to action by the inaugural HIV/TB Global Leaders Forum, participants said the combination of the two diseases means that one person with HIV dies of TB every three minutes, even though TB is both preventable and treatable.
One estimate puts the number of HIV-associated TB deaths at 700,000 annually, according to Kevin De Cock, M.D., director of the World Health Organization's HIV department.
"It's the cause of death of about half the patients dying from AIDS," Dr. De Cock said in a telephone press conference.
Even to cut that in half will need an estimated $19 billion in new money between now and 2015, the forum was told, including about $5 billion for research into new drugs and vaccines.
The forum called on the international community to:
Implement good infection controls to ensure that those with HIV are able to attend health services without fear of contracting TB.
Make sure regular TB screening and preventive treatment is available in all HIV care settings.
Ensure that all TB patients can get HIV counseling and testing and appropriate HIV prevention, treatment, and care.
The call to action came on the eve of a high-level meeting of the U.N. General Assembly called to review progress in the battle against AIDS.
It also came as the U.S. Congress debated re-authorization of the President's Emergency Plan for AIDS Relief, which would contain up to $4 billion for TB.
Dr. De Cock said the U.N. is committed to a goal of universal access to HIV treatment, but that must be coupled with universal access to TB testing and treatment.
"There can be no universal access without universal access to TB prevention, treatment, and care," he said.
Kenyan HIV activist Lucy Cheshire -- herself co-infected at one time with both diseases -- said 205 civil groups from 67 countries are presenting a call to the global leaders to expand TB prevention and treatment.
"That means we ensure every person with TB is offered HIV testing," she said, as well as "ensuring that every person living with HIV is screened for TB."
Experience in several countries in Africa shows better TB care is possible, according to Mario Raviglione, M.D., director of the WHO's Stop TB Department.
In Kenya, for instance, 70% of TB patients were tested for HIV in 2007, up from 19% in 2004. In Rwanda, the proportions went from 0% in 2004 to 80% in 2004, he said.
The issue is especially critical with the advent of new strains of TB that are highly resistant to current medications. So-called extensively drug resistant TB (XDR TB) hits as many 40,000 people a year, according to Dr. Raviglione.
Most of that is in the former Soviet Union and China, he said, but it is also spreading in southern Africa. The most dramatic evidence of the risk came during the 2006 AIDS meeting, when South African researchers reported an outbreak that killed 52 of 53 victims, many within days of infection. Dr. Raviglione said cases of XDR TB are now being reported in Botswana, Namibia, and Lesotho, among other countries. "We believe that XDR is spreading in that part of the continent," he said.
While new molecular methods of testing are under development, they are not likely to be available at the point of care for at least a few years, Dr. Raviglione said. In the meantime, clinicians still rely on the microscope to diagnose TB -- exactly as they have done for more than a century.
He added that about a dozen new drugs are in the pipeline, but new multi-drug regimens are unlikely to be available before about 2015.
Dr. De Cock added that even the current techniques for TB testing are beyond the capabilities of many developing nations. "We need infrastructure as well," he said.
By Michael Smith
NEW YORK, 10 june 2008-- Tuberculosis treatment, prevention, and research needs to be scaled up drastically in conjunction with the battle against HIV/AIDS, speakers at a United Nations forum said today.
In a call to action by the inaugural HIV/TB Global Leaders Forum, participants said the combination of the two diseases means that one person with HIV dies of TB every three minutes, even though TB is both preventable and treatable.
One estimate puts the number of HIV-associated TB deaths at 700,000 annually, according to Kevin De Cock, M.D., director of the World Health Organization's HIV department.
"It's the cause of death of about half the patients dying from AIDS," Dr. De Cock said in a telephone press conference.
Even to cut that in half will need an estimated $19 billion in new money between now and 2015, the forum was told, including about $5 billion for research into new drugs and vaccines.
The forum called on the international community to:
Implement good infection controls to ensure that those with HIV are able to attend health services without fear of contracting TB.
Make sure regular TB screening and preventive treatment is available in all HIV care settings.
Ensure that all TB patients can get HIV counseling and testing and appropriate HIV prevention, treatment, and care.
The call to action came on the eve of a high-level meeting of the U.N. General Assembly called to review progress in the battle against AIDS.
It also came as the U.S. Congress debated re-authorization of the President's Emergency Plan for AIDS Relief, which would contain up to $4 billion for TB.
Dr. De Cock said the U.N. is committed to a goal of universal access to HIV treatment, but that must be coupled with universal access to TB testing and treatment.
"There can be no universal access without universal access to TB prevention, treatment, and care," he said.
Kenyan HIV activist Lucy Cheshire -- herself co-infected at one time with both diseases -- said 205 civil groups from 67 countries are presenting a call to the global leaders to expand TB prevention and treatment.
"That means we ensure every person with TB is offered HIV testing," she said, as well as "ensuring that every person living with HIV is screened for TB."
Experience in several countries in Africa shows better TB care is possible, according to Mario Raviglione, M.D., director of the WHO's Stop TB Department.
In Kenya, for instance, 70% of TB patients were tested for HIV in 2007, up from 19% in 2004. In Rwanda, the proportions went from 0% in 2004 to 80% in 2004, he said.
The issue is especially critical with the advent of new strains of TB that are highly resistant to current medications. So-called extensively drug resistant TB (XDR TB) hits as many 40,000 people a year, according to Dr. Raviglione.
Most of that is in the former Soviet Union and China, he said, but it is also spreading in southern Africa. The most dramatic evidence of the risk came during the 2006 AIDS meeting, when South African researchers reported an outbreak that killed 52 of 53 victims, many within days of infection. Dr. Raviglione said cases of XDR TB are now being reported in Botswana, Namibia, and Lesotho, among other countries. "We believe that XDR is spreading in that part of the continent," he said.
While new molecular methods of testing are under development, they are not likely to be available at the point of care for at least a few years, Dr. Raviglione said. In the meantime, clinicians still rely on the microscope to diagnose TB -- exactly as they have done for more than a century.
He added that about a dozen new drugs are in the pipeline, but new multi-drug regimens are unlikely to be available before about 2015.
Dr. De Cock added that even the current techniques for TB testing are beyond the capabilities of many developing nations. "We need infrastructure as well," he said.
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