WASHINGTON, DC (20 May 2010)—As US policymakers consider
scaling back on its historic initiative to fight AIDS around the
world and downsizing goals to combat tuberculosis, next-generation
treatment and prevention strategies to significantly reduce the
spread of HIV/AIDS and tuberculosis are now imminent. New science
can dramatically change the trajectory of both deadly epidemics,
according to a special new issue of the journal Clinical
Infectious Diseases.
Breakthroughs on the horizon, say the authors, include novel TB
drugs in the pipeline that offer the hope of a safer, faster cure
for both standard TB and drug-resistant TB; TB diagnostic tests
that shrink the time it takes to diagnose drug-resistant TB from
six weeks to 90 minutes; and bold HIV prevention approaches that
include using antiretroviral agents as prophylactics to prevent
against HIV infection, a method known as PrEP, or pre-exposure
prophylaxis.
At a Washington briefing today, the journal articles’ authors
and scientific leaders said that policymakers now need to find ways
to capitalize on these promising advances, and not retreat from an
effort that already has saved countless lives. The briefing
featured Anthony S. Fauci, director of NIH’s National Institute of
Allergy and Infectious Diseases, and other leading
physician-scientists from across the United States.
“Bold new policy, research, and programmatic approaches are
needed to empower the scientific community to take on these twin
diseases,” said Wafaa El-Sadr, MD, MPH, director of the
International Center for AIDS Care and Treatment Programs and
professor of medicine and epidemiology at Columbia University’s
Mailman School of Public Health. “These global health challenges
are surmountable. With the right combination of financial
resources, scientific innovation, and political will, the United
States can lead the effort to save millions of lives from HIV and
TB.”
Publication of the journal comes as U.S. policymakers prepare to
make key decisions in the next few weeks about global health
spending amid an unfolding crisis in inadequate HIV treatment
access in Africa, as well as the emerging threat of
multidrug-resistant TB.
U.S. government officials are seeking to curb costs for treating
AIDS patients overseas and have asked some AIDS treatment centers
in recent months to stop enrolling new patients, depriving them of
life-saving medicines. Expressions of grave concern can be heard
around the world that the United States is backing down from one of
its most successful foreign policy programs in decades. The HIV and
TB epidemics—the world’s two leading infectious disease
killers—claim nearly 10,000 lives every day. The HIV and TB
experts who authored articles in the journal said the United States
must redouble efforts to combat HIV and TB. Several said that
funding for TB, in particular, was woefully inadequate.
“With new TB diagnostics and better drugs in the pipeline, we
have the potential to revolutionize the treatment of tuberculosis,”
said William J. Burman, MD, a leading TB expert and professor of
medicine at the University of Colorado. “When it comes to the TB
epidemic, and particularly the threat of drug-resistant TB, this is
a time of great need—and also a time of great opportunity.”
Tuberculosis is the number one killer of HIV-infected people.
Preventing death from TB in HIV-infected patients is another clear
priority and possible with major scale-up of interventions known to
be effective, according to Burman.
Similarly, nearly three decades after HIV was first recognized,
AIDS remains an incurable, devastating disease, domestically and
globally. But physician-scientists are forging new prevention
paths, from pre-exposure prophylaxis (PrEP) to the “test and treat”
approach, which could make significant inroads in the epidemic,
according to the authors.
“Novel scientific methods of fighting HIV are on the horizon,
but this science must be funded if we want to turn the tide of the
HIV/AIDS epidemic,” said Kenneth Mayer, MD, FIDSA, co-chair of the
Center for Global Health Policy’s Scientific Advisory Committee and
professor at Brown University, where he directs the AIDS
program.
In this special issue of Clinical Infectious Diseases,
entitled “Synergistic Pandemics: Confronting the Global HIV and
Tuberculosis Epidemics,” leading physician-scientists explore many
facets of these dual epidemics. Highlights of the supplement
include:
- Dr. Lynne M. Mofenson, chief of NIH’s Eunice Kennedy Shriver
National Institute of Child Health and Human Development,
Pediatric, Adolescent & Maternal AIDS Branch, examines the
obstacles and opportunities to achieving dramatic reductions in the
number of infants and children who become infected with
HIV—currently 1,000 every day. - The CDC’s lead expert on drug-resistant TB, Dr. J. Peter
Cegielski, details how complacency and neglect of TB led to the
lethal emergence of drug-resistant TB, raising the risk of
repeating history with multidrug-resistant TB and extensively
drug-resistant TB. Dr. William J. Burman and other leading TB
experts describe exciting innovations in TB diagnostics, drugs, and
a vaccine, forging a new path for treatment and control of this
disease. - In the face of lagging HIV prevention efforts and
disappointments in the search for an HIV/AIDS vaccine, urgent new
prevention strategies are needed. Harvard University’s Dr. Victor
DeGruttola and co-authors examine the challenges of evaluating
“test-and-treat strategies,” and Dr. Rochelle Walensky, also of
Harvard, describes the promise of scaling up voluntary HIV
counseling and testing in resource-poor countries. - Dr. Myron Cohen, MD, FIDSA, of the University of North
Carolina, and other leading HIV experts take a hard look at the
potential of antiretroviral therapy (ART) as prevention, discussing
concerns about adherence, drug-resistance, and the impact on sexual
behavior in the search for a “magic bullet” of HIV prevention. - Dr. Gerald Friedland, of Yale University, and co-authors detail
the longstanding “collective neglect” of TB prevention, including
inadequate or nonexistent infection control measures that put
patients and health care workers at risk of TB infection, including
MDR and XDR-TB. Mounting evidence indicates that a major portion of
drug resistant TB is the result of transmission in health care and
other congregate settings, with resultant morbidity, mortality and
ongoing transmission. These could be averted, even in resource
limited settings, by relatively minor improvements in facilities
and the widespread provision of information, motivation and
training in the use of low cost and readily-available air borne
infection control strategies, Dr. Friedland writes. - Dr. Wafaa El-Sadr, of Columbia University, and her co-author
outline simple, yet significant, mechanisms that will allow for
better integration and treatment of TB and HIV in the developing
world, thus making a difference in the outcomes of patients with
both conditions. “Lessons learned” from their first-hand experience
in sub-Saharan Africa can inform the science and implementation of
scale-up of these efforts.
“Workers in the HIV and TB field are at the vanguard of health
systems strengthening, which will be essential to achieve universal
access and primary health care for all persons,” said Mark
Harrington, executive director of the Treatment Action Group.
