Sunday, December 2, 2018

Good news in the fight to stop one of the world’s oldest diseases

When you work in global health, you see a lot of sickness and tragedy. You never get used to it, but after years of visiting hospitals and clinics, I thought I knew generally what to expect.

Dr Andreas Diacon (South Africa) is professor at Stellenbosch University, Cape Town and Chief Executive Officer of Task Applied Science.
Nothing could prepare me, though, for the drug resistant tuberculosis ward I visited in Durban, South Africa in 2009. Every bed was filled, and the waiting list for admission was more than 80 names long. The worst part was the floor that was just for children, including several infants. One baby had XDR-TB, the deadliest and most difficult to treat form of drug-resistant TB. It was truly awful to see.
Soon, however, TB hospitals in South Africa may look very different. Recent scientific breakthroughs mean that many of the wards that used to be full of patients may one day be filled with empty beds instead. That’s a testament to the incredible efforts of TB researchers around the world. One of those amazing scientists is Dr. Andreas Diacon, who founded an organization called TASK.
Dr. Diacon started his career as a TB specialist in Switzerland, where he rarely treated more than five patients at once. TB kills more people than any other infectious disease, but few of them are in level 4countries like Switzerland. Because he was able to spend so much time with each patient, he got to know the ins and outs of the disease better than most. He eventually ended up in Cape Town, overseeing a clinical trial for the first new TB drug in decades.
TB research stalled in the late 20th century, because existing drugs were seen as sufficient, and there was little financial incentive to create new ones. In 2005, Dr. Diacon created TASK to help accelerate the development pipeline for novel TB treatments. The organization started with a staff of five and has grown to 180 employees. They’ve overseen trials of multiple drugs that are now being used to cure patients, including some with drug-resistant TB.
Drug resistance develops when a TB patient takes an insufficient amount of drugs to cure the disease. If a patient doesn’t finish a full course of medication, the bacteria that causes TB can mutate and become resistant to the most common forms of treatment. That mutated bacteria can then spread to other people. About one out of every 20 patients that Dr. Diacon sees has some form of drug resistance.
Even XDR-TB is curable, but not everyone responds to the treatment, and it is pretty brutal. The most common method requires daily injections for up to two years. Because those injections can only be done by a professional, patients who don’t live near a clinic often have to remain hospitalized even after they’re no longer contagious. The drugs can cause a whole range of terrible side effects, including nausea, fatigue, and even hearing loss.
Luckily, there appears to be a better way to treat XDR-TB. Researchers have identified a new three-drug cocktail that requires only six months of treatment. Instead of painful injections, patients take a fixed number of pills (the exact number depends on your weight and age) once a day.
The new course has fewer negative side effects than the injectable one, and there’s no risk of causing deafness. It’s also outpatient based, so people don’t have to stay in the hospital while receiving treatment. Plus, it’s cheaper than other treatments.
Some of these new drugs are already saving lives in South Africa. The country has the highest rate of drug-resistant TB infections per capita in the world, in large part because of the ongoing HIV epidemic (three out of every five TB patients in South Africa are also HIV-positive). With the old, injectable treatment, only 60 percent of those patients were still alive after 50 weeks of treatment. Today, with the new three-drug cocktail, 87 percent survive. That’s a remarkable increase.
Tuberculosis has haunted humanity for millennia—it’s even been found in Egyptian mummies. For most of that time, we had no clue how to stop it. Scientists finally found a cure in the mid-1900s, but it was imperfect, and innovation stalled for decades. Thanks to brilliant scientists in South Africa and around the world—including the team at TASK—we’ve finally moved into the next phase of the fight against tuberculosis.


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