WHO needs to do more to combat XDR-TB, claims report

By Wai Lang Chu

- Last updated on GMT

Related tags: Tb, Tuberculosis

According to the international medical humanitarian organisation
Médecins Sans Frontières (MSF), the World Health Organisation (WHO)
has failed to address the emergence of extensively drug-resistant
(XDR) tuberculosis.

The criticism comes as latest figures show that with approximately 9m people developing active tuberculosis (TB) every year and 1.7m deaths annually, TB victims are expected to soar in number as the Human immunodeficiency virus (HIV) drives the infection rate to unprecedented levels.

The problem is HIV infection dramatically increases the risk of developing active tuberculosis and is driving the TB epidemic in Africa. HIV renders tuberculosis more difficult to diagnose (due to higher incidence of sputum negative disease), and treat (due to interactions and side-effects).

The increasing spread of multidrug-resistant TB (MDR-TB) and the unruly nature of persistent infections pose additional challenges to treatment with currently available anti-TB drugs.

The situation is exacerbated by the increasing emergence of extensively drug-resistant (XDR) TB. Resistance to at least two main first-line drugs and additionally to three or more of the six classes of second-line drugs makes this form of TB virtually untreatable with available drugs.

These observations are fully outlined in a report, produced by MSF, whose analysis warns a greater investment is clearly required to make TB history, something they think the WHO are not doing.

"Business as usual would be a disaster when it comes to treating XDR-TB,"​ said Dr. Françoise Louis, MSF TB and HIV/AIDS advisor.

"XDR-TB has the potential to be devastating in places where HIV/AIDS is widespread. But trying to treat XDR-TB with the tools we have today would be like trying to put out a forest fire with a garden hose."

The report went further, criticising the organisation for failing to respond to the XDR-TB outbreak.

The report said the WHO would need to get newer drugs to patients as soon as possible by working with regulatory agencies and pharmaceutical companies to ensure fast-track clinical development and availability of new drugs for "compassionate use."

In addition, the organisation will also need to push to accelerate the development of more easy-to-use tests.

This will require WHO to take a lead and not simply delegate responsibility to product development partnerships, the report added.

The new analysis, which is being released by MSF as the 37th Union World Conference on Lung Health begins this week in Paris, aims to address the 450,000 new cases of drug resistant TB that are recorded globally each year.

People with XDR-TB are resistant to both of the first-line antibiotics used to treat TB as well as to two classes of second-line drugs, making treatment with existing drugs virtually impossible.

XDR-TB is particularly alarming in the context of HIV, as people who are co-infected with HIV/AIDS could die before test results can confirm their drug resistance.

Using standard drugs to treat XDR-TB without knowing whether there is drug resistance could effectively condemn a patient to death. MSF doctors have been struggling to treat TB with the tools available today, a matter which is exacerbated by the HIV pandemic.

"The XDR-TB outbreaks in southern Africa should sound the alarm for what's going on with TB on a larger scale,"​ said Dr. Tido von Schoen-Angerer, director of MSF's Campaign for Access to Essential Medicines.

"We're still simply not seeing the necessary urgency and major investment into research and development that is needed to make sure the basic science of TB gets translated into newer drugs that can shorten and improve treatment, and diagnostic tests that can be used in resource-poor settings."

The MSF's report can be viewed here.

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