VOL.05    2021.06.24

편집자 한마디!

국내외 결핵(TB) 뉴스

학술연구자료

지난 14일에 WHO의 Global Tuberculosis Program에서 DS-TB치료에 대해 rapid communication을 발표했습니다. WHO가 임상연구결과를 검토한 결과, 효능 및 안전성 측면에서 현재 표준 요법과 비교하여 shorter treatment regimen이 유사한 성과를 보여주었습니다. 더 짧고 효과적이며 full oral 4개월 요법은 빠른 치료를 가능하게 하고 환자와 의료 시스템에 대한 부담을 덜어 줌으로써, 많은 환자와 NTP(국가 결핵 프로그램)로부터 선호될 것입니다. 업데이트된 policy guideline은 2021년 후반에 Module 4: Treatment - Drug-Susceptible Tuberculosis Treatment에서 제공될 예정입니다. MDR-TB에서의 치료기간 단축을 넘어서, DS-TB치료의 치료기간이 단축됨으로써 치료 순응도를 높이고, 환자 및 의료 시스템 비용을 줄일 수 있기를 바라며, WHO의 업데이트를 기다려 봅니다.

A report from United for Global Mental Health, supported by the Elton John AIDS Foundation, confirmed a longstanding suspicion - that integrating basic mental health and psychosocial services into HIV and TB programs will not only help millions of vulnerable people, but will end these epidemics at a faster rate, and in a cost-effective way. As many as 14 million TB infections could be avoided by 2030 with at least 20% faster progress in reducing the TB incidence.

The South African NExT study has found a novel 6 month treatment regimen to be effective for MDR-TB.The trial was performed in five different settings across the country and aimed to determine whether treatment for multidrug-resistant/rifampicin-resistant TB could be shortened to 6 months using oral medication only. Participants were compared with the WHO approved 9-month injectable based regimen.The main comparison metric used in the study (the primary end point) was a WHO-defined favourable outcome 24 months after treatment initiation that was evaluated in each group. The key finding was that the new regimen was more than twice as likely to lead to a favourable outcomes than the traditional approach despite the regimen only being taken for 6 months.

VinBrain and FIT (a German NGO working in the field of TB prevention and control) jointly released a white paper on utilizing artificial intelligence (AI) in TB diagnosis and screening in Vietnam. The white paper provides doctors and medical specialists with a better understanding of the current situation of TB diagnosis, as well as introducing the AI model v1 for TB diagnosis and screening with a sensitivity of 86% and a specificity of up to 96.1%.

On 7 June 2021, the World Health Organization hosted a special high-level event on the side-lines of the UN High-Level Meeting on HIV/AIDS. The event provided a platform for Member States to reassert their commitment to ending TB deaths among people living with HIV and to deliberate on how they will intensify the response to HIV-associated TB within the context of COVID-19. The recording of the event is now available online.

A rapid communication released by the World Health Organization Global Tuberculosis Programme has announced updates to the current treatment regimen for people with drug-susceptible TB. Evidence from the randomised controlled trial TBTC study 31/ACTG A5349, has shown similar performance of a shorter treatment regimen compared to the current standard regimen, both in terms of efficacy and safety. The 4-month regimen, which is shorter, effective and all-oral, would be a preference for many patients and also national TB programmes. Detailed recommendations will be presented in an update later this year of the WHO consolidated guidelines on tuberculosis Module 4: Treatment – Drug Susceptible Tuberculosis Treatment.

The Stop TB Partnership and USAID have launched a report – the first of its kind – assessing the governance of National Tuberculosis Programmes in countries which together account for more than 70% of the global TB burden. The report “Governance of TB Programmes: An assessment of practices in 22 countries” is envisioned to support and strengthen the performance of national-level action against tuberculosis. There are four assessment criteria: transparency (eg the usefulness of the TB programme's website), inclusiveness, legal framework and process efficiency and effectiveness.

USAID has announced USD 57 million for TB programmes in India, Bangladesh, Indonesia, the Philippines, South Africa, Tajikistan and Ukraine. The grant is to help them recover lost ground.

Scientists from Zhengzhou University, investigating the association between TB and COVID-19 severity and mortality, conclude that tuberculosis is significantly associated with an increased risk for severity and mortality among COVID-19 patients.

South Africa’s next strategic plan for HIVTB will be delayed to 2024, owing to the impact of COVID-19, the deputy president. David Mabuza, has announced. Catch-up plans announced by the regions include a TB dashboard for the Western Cape. It resembles the COVID-19 dashboard and will show diagnoses, TB deaths, treatment initiations, successes and preventive therapy numbers.

WHO has put its TB guidelines, operational handbooks and training catalogue all in one place on its new TB Knowledge-Sharing Platform.

The First Lady of China, Peng Liyuan, a WHO goodwill ambassador, has called for global efforts to prevent and treat TB and AIDS. In a video address to a side event at the UNHLM on AIDS, she called on people from all walks of life in all countries to join hands and take action. She said China had kept AIDS prevalence low and in the past 20 years, incidence of TB had dropped by more than 40 per cent in China. Also at the UNHLM, member states adopted a political declaration which includes targets to:

ensure 90 per cent of people living with HIV receive TB preventive treatment

reduce HIV-related TB deaths by 80 per cent by 2025

The Stop TB Partnership and the United States Agency for International Development (USAID) released a new report assessing the governance of National TB Programs in 22 countries which together account for over 70% of the global TB burden. The report is envisioned to support and strengthen the performance of national-level action against TB, a preventable and curable disease, which needlessly kills 4,000 people every day.

Treatment Action Group (TAG) released new training resources for activists and people affected by TB, TB Activist Toolkit and Storyboards. The tools are meant to help build awareness of TB in communities, share information on the latest scientific and policy developments, and inform activism to address barriers to TB diagnosis, treatment, and care.

A team from Dallas report in Nature how they used mathematical modelling and machine learning to characterise a predictive biomarker for TB treatment outcomes. Their objective was to identify TB treatment regimens that were equally as effective in drug-resistant TB as in drug-susceptible TB, to identify regimens that can shorten therapy duration, and to identify early biomarkers that obviate the need for 2-year follow up.

A study published in Nature Communications provides a new measure, called the rRNA synthesis (RS) Ratio,to compare the effectiveness of TB drugs. Researchers measured the degree to which drugs interrupt the synthesis of ribosomal RNA, required for the protein-making machinery of the bacterium. The researchers discovered that drugs and drug regimens that shorten tuberculosis treatment duration inhibit Mtb rRNA synthesis more than less potent drugs and regimens.

Low-dose amikacin with appropriate dose adjustment based on adequate monitoring demonstrated limited toxicity with positive outcomes as a treatment option for multidrug-resistant tuberculosis (MDR-TB), according to the findings of a retrospective cohort study published in BMC Infectious Diseases.

M.tb can survive for decades within its human host by varying its diet to successfully steal nutrients, including immune cells;it is known to acquire and absorb multiple carbon sources from the body during infection. UK scientists measured the flow of metabolites or "fluxes" through metabolic pathways when M.tb is consuming some of its favourite nutrients. Measuring these 'fluxes' could help scientists advance new tuberculosis drugs as well as understand why the bacterium survives so long in humans and why current antibiotics are often ineffective.

A study published in Nature Immunology offered insights into the immune system that may help explain why some people have latent TB infection and others develop active TB disease.

According to a prospective, cross-sectional diagnostic study published in JAMA Pediatrics, the far less-invasive collection and testing of nasopharyngeal aspirate samples in combination with stool and urine sample testing may improve the diagnosis of TB in children in limited-resource settings.

According to study findings published in Clinical Infectious Diseases, a programmatic latent TB infection (LTBI) intervention led to completion rates of 92.7% for LTBI screening and 82.5% for TB preventive therapy among elderly patients with poorly controlled diabetes.

Researchers found an association between region of birth and time to diagnosis among foreign-born people in the U.S. with TB, suggesting that where a person was born may predict progression from latent TB to TB disease.

RESIST-TB released its May 2021 newsletter with the latest research publications on drug-resistant TB. To access the newsletter, click here.

The International Journal of Tuberculosis and Lung Disease (IJTLD) is the official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It publishes articles on all aspects of lung health. IJTLD June 2021 issue is available here.