Evidence for treatment policy for HIV/infected TB patients: Business Plan 2008-2013
Resource limited countries are constrained in their ability to cope with the rising burden of HIV driven TB due to the limited evidence on strategies to optimize treatment and case management. For example, when TB occurs concomitantly with HIV and, given the recent WHO - promoted scale-up of ARV therapy, there is an increasing need to define optimal timing of ARV therapy during TB treatment and to find better alternative to current drug regimens (particularly rifampicin) that minimize drug interactions and side-effects. Independent of HIV status, the long duration of treatment required with the current regimens is an obstacle to effective TB control. Drugs like fluoroquinolones may allow for simpler, shorter regimens; these regimens must be tested, developed and registered. We also need to better understand and address the frequent occurrence of IRIS (immune reconstitution inflammatory syndrome). Identifying biological or pathogen surrogate markers will facilitate monitoring disease activity and treatment response, with the potential to accelerate treatment evaluation and drug registration. Lastly, there is a compelling need to identify constraints in accessing diagnosis and care of individuals suffering from TB and/or HIV co-infection and successfully addressing ‘real-life’ factors affecting adherence to treatment (including issues related to gender). While these challenges are enormous there is a strong momentum to address these issues through the Stop TB Partnership, a global alliance of over 400 organizations, which aims to halve TB prevalence and deaths by 2015, partly through investment in R&D.