Access to new test for drug-resistant TB must be improved: WHO expert

A World Health Organization expert called for greater access to a new diagnostic tool for multidrug-resistant tuberculosis (MDR-TB) in the Western Pacific and southeast Asia.  The new diagnostic tool reduces the time needed to detect MDR-TB from eight weeks to two hours.

Drug-resistant TB emerges when patients fail to follow treatment regimens, take substandard drugs or stop treatment too early.  Patients with MDR-TB can then transmit the disease to others.

According to the WHO, there are 120,000 new cases of MDR-TB in the Western Pacific each year, which makes up 28 percent of the global caseload.  Combined with cases in southeast Asia, all MDR-TB cases in Asia make up 58 percent of the global caseload.

Number of drug-resistant TB cases, 2007

• India – 131,000
• China – 112,000
• Russia – 43,000
• Bangladesh – 15,000
• South Africa – 16,000

TB killed 1.8 million people across the world in 2008, or a person every 20 seconds. It is not only a scourge in poor countries but also in the West, where it has flared anew in the last 20 years because of AIDS, which weakens the immune system.

Vaccine development – recent history and future promise

During the past two decades, the number of diseases that can be prevented by vaccines has doubled, according to the Centers for Disease Control and Prevention.  Experts say the 21st century holds even more promise for new vaccines. (AMA News)

Scientists are exploring new frontiers where vaccines can be developed in plants. Other possible advancements include using a patch to immunize patients instead of needles.

The upswing in vaccine development, after a slowdown in the 1970s and 1980s, has not been without stumbling blocks. The advanced technology used to develop new vaccines has made them too expensive for some physicians to purchase, store and administer. Outdated manufacturing systems have struggled to keep up with demand.

And even the success of vaccines can have negative effects — some parents choose not to immunize their children, in part, because they no longer think there is a need.

The anti-immunization movement has led to the resurgence of potentially fatal diseases such as mumps and pertussis.

The following is a timeline of vaccine development from 1914 to 2010.  A slideshow of the timeline is also available on the American Medical Association site.

Circumcision could prevent 4 million new HIV cases in Africa

More than 4 million new HIV infections could be prevented in eastern and southern Africa by 2025 if male circumcision rates were increased to 80 percent, researchers said on Tuesday.  Expanding circumcision services to 80 percent of adult and newborn males in the region would also save $20.2 billion in HIV-related health costs between 2009 and 2025.  (Reuters)

Research cited by the World Health Organization has shown that male circumcision can reduce a man’s risk of getting HIV by up to 60 percent.

In March 2007, the WHO and United Nations UNAIDS group recommended male circumcision as an effective HIV prevention.

WHO report: more than 5 million in developing countries receiving HIV treatment

Today, the World Health Organization (WHO) issued a press release praising a dramatic increase in access to HIV treatment in developing countries, while advising earlier adoption of treatment to reduce mortality.

According to the WHO, an estimated 5.2 million people in low and middle-income countries were receiving life-saving HIV treatment at the end of 2009 — an increase of 1.2 million from 2008.  To further build on this push to fight HIV/AIDS, the WHO recommended that HIV+ patients begin treatment sooner, as that could reduce related mortality by an estimated 20%.  Earlier treatment can prevent opportunistic infections including tuberculosis (TB), the number one killer of people with HIV. Deaths from TB can be reduced by as much as 90%, if people with both HIV and TB start treatment earlier.

19 JULY 2010 | GENEVA | VIENNA — An estimated 5.2 million people in low and middle-income countries were receiving life-saving HIV treatment at the end of 2009, according to the latest update from WHO.

WHO estimates that 1.2 million people started treatment in 2009, bringing the total number of people receiving treatment to 5.2 million, compared to 4 million at the end of 2008.

“This is the largest increase in people accessing treatment in a single year. It is an extremely encouraging development,” says Dr Hiroki Nakatani, WHO Assistant Director-General for HIV, Tuberculosis, Malaria and Neglected Tropical Diseases.

At the XVIII International AIDS Conference, WHO is calling for earlier treatment for people with HIV. The objective is to begin HIV treatment before they become ill because of weakened immunity.

“Starting treatment earlier gives us an opportunity to enable people living with HIV to stay healthier and live longer,” says Dr Gottfried Hirnschall, WHO Director of HIV/AIDS.

Estimates developed through epidemiological modeling suggest that HIV-related mortality can be reduced by 20% between 2010 and 2015 if these guidelines for early treatment are broadly implemented.

Earlier treatment can prevent opportunistic infections including tuberculosis (TB), the number one killer of people with HIV. Deaths from TB can be reduced by as much as 90%, if people with both HIV and TB start treatment earlier.

The strength of a person’s immune system is measured by CD4 cells. A healthy person has a CD4 count of 1000 – 1500 cells/mm3. WHO previously recommended starting HIV treatment when a person’s CD4 count drops below 200 cells/mm3 but now advises starting HIV treatment at 350 cells/mm3 or below.

“In addition to saving lives, earlier treatment also has prevention benefits,” Dr Hirnschall says. “Because treatment reduces the level of virus in the body, it means HIV-positive people are less likely to pass the virus on to their partners.”

WHO’s treatment guidelines expand the number of people recommended for HIV treatment from an estimated 10 million to an estimated 15 million. The cost needed for HIV treatment in 2010 will be about US$ 9 billion, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

“The investments we make today can not only save millions of lives but millions of dollars tomorrow,” said Dr Bernhard Schwartlander, Director, Evidence, Strategy and Results, UNAIDS. “People with weaker immune systems who come late for treatment require more complex and costly drugs and services than those who start treatment earlier and are healthier.

Since 2003 – which marked the launch of the historic “3 by 5” initiative to provide access to HIV treatment to 3 million people living in low- and middle-income countries by the end of 2005 – the number of people receiving HIV treatment has increased 12-fold.

At AIDS 2010, WHO is releasing the 2010 guidelines on Antiretroviral treatment of HIV infection in adults and adolescents – public health approach.

XVIII International AIDS Conference: July 18 – 23

The XVIII International AIDS Conference is being held this year in Vienna, Austria from July 18-23.  The conference looks to build on the dialogue that began in Mexico City in 2008 about the connection between human rights and HIV.  The meeting also coincides with a major push for expanded access to HIV prevention, treatment, care and support.

Many of the conference sessions will be made available by webcast, including:

July 18

• HIV and Millennium Development Goals: Can We Do One Without the Other?

• Advancing Country Ownership: Achieving Program Sustainability and Long-Term Impact

July 19

• Building on Success: A Roadmap for HIV Prevention

July 20

• The Future of Universal Access

July 21

• Funding Global Health: Can Innovative Mechanisms Save the Day?

• When Does HIV Funding Strengthen Health Systems?

WHO reports progress in fight against drug-resistant malaria

Efforts to eliminate a drug-resistant strain of malaria near the Cambodian-Thai border have shown signs of success, according to the World Health Organization and local health officials. (reported by AFP)

The WHO warned early last year that the emergence of parasites resistant to artemisinin along the Cambodia-Thai border could “seriously undermine” efforts to bring the disease under control.

But initial results from the screening of 2,782 villagers in Cambodia’s Pailin province found only two cases of falciparum malaria, the deadliest type of the disease and the one in which resistance to artemisinin has emerged.

A malaria control project launched last year, has distributed more than half a million mosquito nets and trained and equipped more than 3,000 village malaria workers in diagnosis and treatment on both sides of the border.

The director of Cambodia’s National Centre for Malaria Control, said the results suggested the efforts are “significantly reducing the cases of malaria and could ultimately eliminate the resistant parasites from the area.”

New artemisinin-based medication has been largely credited in recent years for increasing recovery rates from the mosquito-transmitted disease that kills one million people a year, mostly in Africa.

Fighting neglected diseases: anti-TB compounds offer hope

Compounds being developed against tuberculosis also show promise against deadly tropical diseases threatening millions of people.  As reported by Reuters, the Global Alliance for TB Drug Development has granted the Drugs for Neglected Diseases Initiative (DNDi) rights to develop a class of potential anti-TB compounds offering hope of treating Chagas disease, African sleeping sickness and leishmaniasis.

Chagas, a disease caused by a parasite found mainly in rural areas of Latin America, kills some 14,000 people annually and an estimated 8 million are infected. Infection is lifelong and can lead to heart disease and heart failure. Some 100 million people are deemed at risk of the disease.

Leishmaniasis and sleeping sickness, formally known as human African trypanosomiasis, each kill roughly 50,000 people a year and pose a threat to a combined total of 400 million people.

The Gates Foundation is providing a $1.5 million grant to DNDi for preclinical assessments of compounds specifically for use against visceral leishmaniasis, a deadly parasitic infection spread by the bite of a sandfly.

Though found in Europe, Asia and Africa, leishmaniasis is most concentrated in India. An estimated 350 million people worldwide are deemed at risk from infection.

Cutting drug prices hampers innovation: study

Cutting pharmaceutical prices in the way European governments are doing now will severely reduce the number of new drugs making it to market.  There is a direct link between strict regulation and low innovation in the sector, according to a study by a Berlin-based European School of Management and Technology Competition Analysis (EMST CA) and commissioned by the drugmaker Novartis (download a PDF of the full study).

The EMST report said that while European governments predominantly see pharmaceutical pricing models as a way of controlling public health costs, they may not realize or acknowledge the implications for product value, and therefore for the development of new drugs.

The report goes on to argue that current pricing models “are often shown to favor ‘breakthrough’ pharmaceutical innovations over ‘follow-on’ drugs, or incremental improvements”.  This can lead to ‘a different understanding of innovation for patients and chemists’, the study states.

For example, a statin may be redeveloped to have fewer side effects or be more beneficial for one group of patients and while this will seem like an innovative development to the patient, “it will not necessarily be innovative enough from the pricing regulator’s point of view to benefit from favorable regulation”.

The report concludes by saying that the analysis “demonstrates the need to support both ‘first in class’ and ‘best in class’ products, rather than drawing a regulatory distinction between ‘breakthrough’ products and everything else”.