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January 28, 2014

UVA, Russia experts target growing threat of drug-resistant TB

Researchers at the University of Virginia School of Medicine and colleagues in Russia are launching an ambitious effort to check the growing public health threat posed by drug-resistant tuberculosis , especially to people with HIV, in the Siberian city of Irkutsk. It’s a critically important mission, both for the people there and because of the risk that international travel could facilitate the spread of the disease around the world.

Recognizing the importance of the work, the U.S. National Institutes of Health and its Russian counterpart, the Russian Federation for Basic Research, have agreed to fund the effort to improve tuberculosis diagnosis and care in Irkutsk. The UVA researchers have received a $342,598 grant over the next two years from the National Institute of Allergy and Infectious Diseases.

“The unique thing about the grant is that it is an equal partnership between Russia and U.S. institutions,” said Scott Heysell, MD, MPH, of UVA’s Division of Infectious Diseases and International Health. “It had to receive approval both at the NIH and the Russian equivalent, so we felt like this was a really unusual grant for our division and for UVA.”

The Paris of Siberia

Irkutsk is sometimes called the “Paris of Siberia” because so many artists, scholars and intellectuals were exiled there starting in the 19th century. Today it remains a cosmopolitan city and a major transportation hub for Siberia. It is plagued, however, by a serious problem with multidrug-resistant tuberculosis. “All across Russia, but especially in Siberia, there are extraordinarily high rates of multidrug-resistant TB,” explained UVA’s Eric Houpt, MD, of the Division of Infectious Diseases. “In the U.S., the rates are about 1 percent total, and out there, it’s about 30 percent.”

In the wake of the fall of the Soviet Union, treatment for tuberculosis became unavailable or intermittent, allowing the bacteria to become more resistant to the medicines used to treat it. Use of injectable drugs, high rates of HIV infection and crowding among prison inmates have exacerbated the drug-resistant TB situation in Irkutsk. “This is very, very difficult to treat,” Heysell said. “The difference between drug-resistant TB and drug-susceptible TB is that you can treat drug-susceptible TB in six months with oral medications, whereas it takes 18 months of more to treat drug-resistant TB and requires intravenous medications. In a well-resourced setting, the cure rates are above 90-95 percent for patients with drug-susceptible TB, but in many parts of the world it drops below 50 percent for drug-resistant tuberculosis, and that’s certainly the case in Irkutsk.”

The disease is even more deadly for those infected with both HIV and drug-resistant TB.

Tuberculosis Treatment

The UVA researchers and their Russian collaborators aim to change that. They will use their grant money to accomplish three main goals in Irkutsk:

Enhancing doctors’ ability to test TB specimens to determine quickly the pattern of drug resistance, allowing doctors to devise more effective treatment regimens. Increasing the early screening and detection of TB and drug-resistant TB among people with HIV. Evaluating how well TB drugs are being absorbed, paving the way towards medication dose adjustment.

“Through these three things – improved case finding, improved diagnostics and enhanced treatment – we think we can drop the mortality rate pretty far,” Houpt said.

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