The Tuberculosis War: Fighting the Spread of TB

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"This is an infectious disease that is curable, and we just have old drugs to deal with it," said Goldfeld, who has done landmark work treating the co-infection of HIV and TB, a common and deadly combination. As the body weakens from HIV, without proper medication, TB moves in with fatal results.

Goldfeld has studied the best course of treatment and to determine when drugs for the co-infection should be introduced, but she is frustrated the world has not paid more attention to this new TB epidemic.

"I think everyone needs to ask themselves the question of why some people do not have access to medicines to treat a curable disease," said Goldfeld. "It's basically that if you are poor, you do not have the same access to medicines as people who are rich or who live in resource-rich countries."

The lack of a good diagnostic tool is making this epidemic much worse. It can take weeks, or even months, to find out which kind of TB a patient has. To make matters worse, if patients are not treated, or treated improperly, or go off medications, they can develop what is known as multiple-drug resistant TB, or MDR, and exacerbate it. That takes up to two years to treat, with painful and expensive drugs.

The average untreated MDR TB patient infects 12 to 15 people in his or her lifetime; they in turn infect the same number. Hence, the epidemic. According to the World Health Organization, Asia has the highest number of reported cases of drug-resistant TB.

But now, there is a new tool in the fight against TB: the GeneXpert, manufactured in California. It can analyze the genetic makeup of a sputum sample and diagnose in two hours what usually takes up to two months. The GeneXpert was developed with input by the Pentagon after the anthrax scare in 2001.

It looks something like a coffee machine, but costs about $20,000. Goldfeld is lucky enough to have one in Phnom Penh, where she is conducting a study with several colleagues to see how well the GeneXpert can diagnose TB in children. Because they don't generate enough sputum necessary for a TB test, it is potentially more difficult to use the GeneXpert for children. Results of the study are not expected for several months.

Last week, the World Health Organization endorsed the use of GeneXpert to diagnose TB, which infects more than nine million people a year. At the same time, the manufacturer, Cepheid, said it would offer a 75 percent reduction in the price of GeneXperts for countries most affected by TB.

Also key to fighting the epidemic is early detection and treatment of people showing symptoms, using community- based approaches to deliver care, as Goldfeld and Sok Thim have done in Cambodia.

Goldfeld says there are ways to help treat TB that don't require an expensive, high tech machine. A $20 donation to the Cambodian Health Committee can pay for an entire course of non-MDR TB treatment, or for a health worker to deliver drugs for MDR at a patient's home on a daily basis for a month

Goldfeld is also in the early stages of expanding her TB and HIV work in Ethiopia, a country of 85 million, with tens of thousands of cases of TB and HIV-TB co-infection. In Africa, TB is one of the leading causes of death for people with HIV.

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