An international effort led by physician-scientists at
Johns Hopkins to control the global
spread of HIV-related tuberculosis and treat the dual
epidemics in hardest-hit countries has received
$32 million in additional funding from the Bill & Melinda
Gates Foundation.
Officials of the Seattle-based foundation and Johns
Hopkins announced the award last week in
Paris in advance of the 2008 World Conference on Lung
Health and the International Union Against
Tuberculosis and Lung Disease that began Oct. 16.
The new support for the Johns Hopkins-based Consortium
to Respond Effectively to the
AIDS/TB Epidemic, or CREATE, complements the $44.7 million
given by the Gates Foundation in 2004
to start the initiative, considered the largest TB-related
research effort in the world. More than 250
researchers and dozens of health policy experts in Africa,
South America, Europe and the United
States are part of the effort.
CREATE currently sponsors three major clinical trials
in South Africa, Brazil and Zambia on the
use of antibiotic therapy to prevent TB and how actively
screening people for the disease can be used
to prevent its spread in communities where HIV is epidemic.
A major goal for researchers is to use
the studies as evidence for reforming public health
worldwide to promote a stronger implementation
of TB prevention policies.
Johns Hopkins infectious disease specialist Richard
Chaisson, who leads CREATE, said the
added resources come at "a pivotal juncture, just as our
team's research is making serious progress" in
finding drug therapies that prevent people from becoming
infected with Mycobacterium tuberculosis
in the first place.
Preliminary survey findings last year from the CREATE
study in Rio de Janeiro offered the
first evidence that combination antiretroviral therapy with
the antibiotic isoniazid could confer the
best chance of preventing active TB disease in people
co-infected with HIV and TB.
American and Brazilian researchers found that
combining isoniazid with highly active
antiretroviral therapy, known as HAART, is more effective
than either therapy on its own. Among
those treated with both drugs, the risk of developing TB
disease was reduced by 80 percent.
Isoniazid on its own reduced the frequency of disease from
the highly contagious tubercle bacillus by
32 percent.
Scientists have known for years that HAART on its own
reduced the risk of TB (by 51 percent
in this survey), but they did not know until now the drugs'
combined effects.
"This boost in research funding is a major vote of
confidence in our team's efforts to deliver
innovative public health strategies designed to help people
suffering from the deadly twin epidemics
of TB and HIV," said Chaisson, a professor of
medicine,
epidemiology and
international health at the School of Medicine.
"TB is now the leading killer of people with HIV
worldwide," he said. "Because HIV weakens the
immune system, people with HIV are especially vulnerable to
TB, and TB rates have increased
significantly in countries with high HIV prevalence. We are
testing simple interventions at the
community level that can reverse these deadly trends."
Chaisson noted that worldwide, each year, nearly 9
million new cases of TB are diagnosed, and
more than 1.5 million people die from the disease. In
sub-Saharan Africa, one-quarter of the
estimated 1.6 million deaths caused by TB annually occur
among people living with HIV/AIDS. The
World Health Organization estimates that by the year 2020,
1 billion people worldwide will be
infected with tuberculosis, of whom 200 million will fall
ill and 35 million will die.
Other organizations collaborating with CREATE on the
studies in South Africa, Brazil and
Zambia are the London School of Hygiene and Tropical
Medicine, the Desmond Tutu Tuberculosis
Centre at the University of Stellenbosh, the Rio de Janeiro
Municipal Health Secretariat, the Aurum
Institute for Health Research, the Zambia AIDS-related TB
Project and WHO.
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