Report Calls Tuberculosis 'Neglected Sister'

(May 19) -- Tuberculosis remains a deadly disease that's getting inadequate attention from the international medical community, according to a major report published this week.

TB infected 9 million people in the last year alone, and killed 2 million, health officials report. While other global ailments, like HIV and malaria, are seeing decreased prevalence and major funding and research efforts, rates of tuberculosis are hardly budging. It's a troubling trend that makes TB "the neglected sister of HIV and malaria," according to the special report in the Lancet medical journal.

"Tuberculosis is unfashionable these days," Mphu Ramatlapeng, health minister of Lesotho, said at a World Health Organization press conference in Geneva, where the report was released.

Maybe so, but the illness remains remarkably prevalent in a handful of countries. More than 80 percent of TB occurs in 22 nations, mostly African and Asian. In those countries, only 40 percent of TB infections are even treated.

Here in the U.S, rates of tuberculosis continue to decline. In 2009, 11,540 cases of tuberculosis were reported to the Centers for Disease Control and Prevention. That's an 11 percent drop from 2008, and the largest one-year decrease in TB cases that the CDC has ever recorded.

Researchers want the medical community to zero in on the co-occurrence of tuberculosis with HIV, which significantly increases one's risk of contracting TB. By doing a better job of diagnosing HIV and providing patients with immune-boosting drugs, vulnerable countries could reduce TB rates.

When it's caught early, TB can be treated with an expensive round of drugs. But if left to linger, the illness can develop a resistance to common front-line meds, and more advanced treatment costs around $3,500 -- for a single patient -- and takes years to work.

"Without significant investment in technology and capacity for prevention, diagnosis and treatment, [multi-drug-resistant TB] threatens to become the dominant strain of TB over the next few decades," the study reads. "The future possibility of strains that are totally resistant to all anti-tuberculosis drugs is not inconceivable."

Drug-resistant infections, of which 440,000 occurred in 2008, are also less likely to be treated at all. Only 7 percent were adequately mitigated in 2008.

Aggressively targeting TB will require better public education efforts, preventive measures, improved diagnostic tests and the development of new treatment methods. But health agencies need money, the report stresses.

And while TB treatment efforts are largely handled by the WHO, some experts who contributed to the Lancet report want to see that change -- mostly, they say, because mitigating TB means drastic changes to overall living conditions.

"The main priority for TB control is improved living conditions and economic growth, which is outside the control of the U.N.," said Philip Stevens, a health policy expert at London's International Policy Network. "TB cannot be tackled in isolation."

WHO officials, however, defend the progress of their global TB initiative, which cured 36 million people between 1995 and 2008.

TB could be largely eradicated by 2050, according to experts behind another paper in the Lancet report. But it will take a major boost in funding, especially with regard to new strains of drugs.

"Development of new drugs for TB is lengthy, expensive, and risky, and the expected revenues are too small to justify commercial investment," according to the Lancet report. "New financing and market incentive mechanisms are needed."

For now, however, WHO officials and other health agencies are just trying to get a sense of how serious the TB problem -- particularly the issue of drug resistance -- really is.

"It is surprising how much data we're lacking," Pamela Das, Lancet's executive editor, wrote in a commentary accompanying the report. "There are so many gaps that we don't really know what's going on."