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Lax drug care fortifying HIV, TB?
Lax drug care fortifying HIV, TB?
Deseret Morning News
Delivery of drugs that reduce symptoms and improve quality of life but don't cure HIV or tuberculosis may actually promote spread of the diseases and increase drug-resistance, unless steps are taken to ensure compliance with treatment plans, an infectious-disease expert warns.
"If we continue to make antiretrovirals available in an uncontrolled, ungoverned system, we will create a maelstrom of drug-resistant HIV and TB, with grim and lethal consequences for decades to come," said Dr. Michael D. Iseman of the National Jewish Medical and Research Center in Denver.
His warning came during a memorial lecture Tuesday at the annual conference of the American College of Chest Physicians at the Salt Palace in Salt Lake City.
Of particular concern, Iseman said, is the goal that was announced at an international HIV conference in Toronto to see that everyone has access to antiretrovirals by 2010. First, it's not realistic, he said. But it's also "fraught with hazard.
"No one can argue against nobel ideas. But I'm skeptical about the ability to deliver."
Iseman, an internationally known expert on infectious disease, said that the number of programs offering HIV/AIDS treatment far exceeds those that can do it really well. Doing it poorly is likely to exacerbate the HIV/AIDS epidemic.
He pointed to TB treatment in the 1950s and '60s, when inadequate treatment "prevented death but fostered more spread and resistance." And again with TB in New York City in the '80s and '90s: "Low cure rates, rising morbidity and soaring resistance."
Even treatment settings can promote spread. In an outbreak of recent drug-resistant TB in South Africa, 80 percent of the spread occurred in the hospital where people were brought for help.
Compliance is one of the biggest problems, he said. Both TB and HIV require use of therapies even during those times when there are no symptoms. And the side effects and toxicity "are not inconsequential," he said. So people don't comply. Or they skip doses. Or they take time outs. And partial therapy leads to treatment failure, but longer survival, which may increase spread of the disease, as well as likelihood drug-resistant strains will develop.
Virtually all drug-resistant TB has resulted from treatment failure and partial therapy, said Iseman. The same issues exist with HIV/AIDS treatment.
He drew parallels between TB and HIV to make his point. The two infectious diseases often coexist in the same patients and Iseman sees "uncanny" parallels between them. Both are spread person to person. Both lead to a chronic, protracted illness. And their primary natural targets are young adults.
Despite 75 years of working on it, there's no vaccine for TB, and the past 15 years have not yielded one for HIV, either, he said. And unlike some deadly infections such as Ebola, which kill rapidly, patients with TB or HIV live for months or even years during which they can still spread infection.
"Will the impulse to do good be so overwhelming we can't resist making drugs readily available?" he asked. In developing nations, where HIV/AIDS is rampant, the greatest need is "infra- structure, infrastructure, infrastructure" before treatment efforts can move forward effectively, Iseman said.
"We must act," he warned, "but with prudence and awareness of unintended consequences."
http://deseretnews.com/dn/view/0,1249,650201486,00.html
Deseret Morning News
Delivery of drugs that reduce symptoms and improve quality of life but don't cure HIV or tuberculosis may actually promote spread of the diseases and increase drug-resistance, unless steps are taken to ensure compliance with treatment plans, an infectious-disease expert warns.
"If we continue to make antiretrovirals available in an uncontrolled, ungoverned system, we will create a maelstrom of drug-resistant HIV and TB, with grim and lethal consequences for decades to come," said Dr. Michael D. Iseman of the National Jewish Medical and Research Center in Denver.
His warning came during a memorial lecture Tuesday at the annual conference of the American College of Chest Physicians at the Salt Palace in Salt Lake City.
Of particular concern, Iseman said, is the goal that was announced at an international HIV conference in Toronto to see that everyone has access to antiretrovirals by 2010. First, it's not realistic, he said. But it's also "fraught with hazard.
"No one can argue against nobel ideas. But I'm skeptical about the ability to deliver."
Iseman, an internationally known expert on infectious disease, said that the number of programs offering HIV/AIDS treatment far exceeds those that can do it really well. Doing it poorly is likely to exacerbate the HIV/AIDS epidemic.
He pointed to TB treatment in the 1950s and '60s, when inadequate treatment "prevented death but fostered more spread and resistance." And again with TB in New York City in the '80s and '90s: "Low cure rates, rising morbidity and soaring resistance."
Even treatment settings can promote spread. In an outbreak of recent drug-resistant TB in South Africa, 80 percent of the spread occurred in the hospital where people were brought for help.
Compliance is one of the biggest problems, he said. Both TB and HIV require use of therapies even during those times when there are no symptoms. And the side effects and toxicity "are not inconsequential," he said. So people don't comply. Or they skip doses. Or they take time outs. And partial therapy leads to treatment failure, but longer survival, which may increase spread of the disease, as well as likelihood drug-resistant strains will develop.
Virtually all drug-resistant TB has resulted from treatment failure and partial therapy, said Iseman. The same issues exist with HIV/AIDS treatment.
He drew parallels between TB and HIV to make his point. The two infectious diseases often coexist in the same patients and Iseman sees "uncanny" parallels between them. Both are spread person to person. Both lead to a chronic, protracted illness. And their primary natural targets are young adults.
Despite 75 years of working on it, there's no vaccine for TB, and the past 15 years have not yielded one for HIV, either, he said. And unlike some deadly infections such as Ebola, which kill rapidly, patients with TB or HIV live for months or even years during which they can still spread infection.
"Will the impulse to do good be so overwhelming we can't resist making drugs readily available?" he asked. In developing nations, where HIV/AIDS is rampant, the greatest need is "infra- structure, infrastructure, infrastructure" before treatment efforts can move forward effectively, Iseman said.
"We must act," he warned, "but with prudence and awareness of unintended consequences."
http://deseretnews.com/dn/view/0,1249,650201486,00.html