What If TB, HIV Medicines Stop Working? Experts Unite Against Drug Resistance


One year and 10 months ago when first case of corona
virus was reported in Wuhan, China, entire world was
terrified because no one knew if we have any medicine that
will work against it. Possibly our worst fears came true and
we witnessed the horrendous impact of the pandemic. One
silver lining in dark Covid cloud is the hard-taught lesson
to value the medicines we have, which try to cure and heal
us from range of illnesses. We cannot afford to lose these
lifesaving medicines. One major threat because of which
medicines stop working against bugs that make us ill is
Antimicrobial Resistance (AMR).

AMR in tuberculosis
(TB) and HIV has long been referred to as drug resistance.
“TB and HIV drug resistance threatens the effective
prevention and treatment. When drug resistance develops, the
TB bacteria and AIDS virus change so that they no longer
respond to medicines, making infections harder to treat,
more expensive to treat, and increasing the risk of disease
spread, severe illness and death” said Dr Ishwar Gilada,
President of ASI (AIDS Society of India), who is credited to
be among the first Indian doctors to begin medical
management of HIV when first case got diagnosed in the
country.

World Antimicrobial Resistance Awareness
Week

World Antimicrobial Resistance Awareness Week
(WAAW) will be observed during 18-24 November 2021. A month
before that, Dr Ishwar Gilada and Dr Sudarshan Mandal, head
of Indian government’s National TB Elimination Programme
(NTEP), co-chaired a high level ASI Advisory Board Meeting
on managing TB and HIV drug resistance.

Combating drug
resistance is a more compelling priority than ever
before

Dr Gilada added: “We cannot afford to lose
lifesaving medicines for TB and HIV at this critical
juncture when all countries in the world have committed to
end AIDS and TB by 2030 (only 110 months left to meet the
goal). India stands firm to end TB by 2025 (only 50 months
are left). Combating drug resistance is a more compelling
priority than ever before.”

Covid pandemic forced an
unprecedented global public health emergency, and measures
taken to curb the corona virus jeopardised essential and
critical public health services. TB and HIV services were no
different as they too got impacted the most where they were
needed most (in high burden nations and
settings).

“Covid-19 pandemic has been grossly
responsible for exacerbating neglect of several other
diseases that were already impacting our populations in
epidemic proportions, thus caused a terrible collateral
damage. As the pandemic is receding, we are duty bound to
focus on other pressing health challenges. TB and HIV care
is among those health priorities that slipped off the radar
since the beginning of the Covid pandemic. A recent study
estimated additional 20% rise in TB deaths and 10% rise in
HIV deaths in five years in the country due to Covid
pandemic. It is high time to not lose the major advances
India has made in fighting both: TB and HIV, and accelerate
progress towards ending AIDS and TB both as committed by the
government of India. Alarming levels of drug resistance has
been puncturing both TB and HIV responses globally”
emphasized Dr Ishwar Gilada, who is also the Secretary
General of Organized Medicine Academic Guild
(OMAG).

Important early step towards possible BPaL
rollout in India

Dr Vikas S Oswal, Chest Consultant,
National TB Elimination Programme (NTEP) trainer and
Chairperson of DPS Shatabdi Municipal Hospital in Mumbai,
emphasized on the need of timely and rational use of latest
more effective, less toxic and shorter duration treatment
therapies for multidrug-resistant TB, which also works with
comparable efficacy for people co-infected with HIV. Dr
Oswal is also leading India’s first site where rollout of
latest treatment for drug-resistant TB has begun yesterday
(under research study and restricted access mode), results
of which will help guide India’s policy, programme and
further actions. This potentially game changing treatment is
called BPaL (Bedaquiline, Pretomanid and
Linezolid).

Reduce dose of potentially toxic drug,
says Dr Ameet Dravid

Dr Ameet Dravid, a noted expert
on HIV and infectious diseases from Ruby Hall Clinic and
Poona Hospital said that as per latest WHO Global TB Report,
in India, almost half a million (4.45 lakhs) TB deaths
occurred in 2019, which includes 9,500 deaths among people
with HIV. 71,000 people living with HIV fell ill with TB in
the country in 2019 out of which 44517 people were notified
and were on lifesaving antiretroviral treatment. In 2019,
124,000 in India were estimated to have drug-resistant TB
out of which only 56,569 were put on possible treatment. Dr
Ameet Dravid emphasized the importance of scientific
evidence-based recommendation of dose reduction of a
potentially toxic drug, Linezolid, from 1200mg per day to
600 mg daily while treating MDR-TB.

Dr Ishwar Gilada
who has led People’s Health Organization for more than
three decades and is among the longest serving HIV medical
experts in India, is deeply pained to see that TB continues
to be the commonest and deadliest of the opportunistic
infections for people living with HIV even today – this is
not acceptable as we know how to prevent infection spread,
reduce risk of latent TB converting into active disease, and
also know how to accurately diagnose and treat TB.
Preventing TB especially among those at high risk is an
imperative for public health.

Dr Gilada said that
every case of active TB disease (as well as primary drug
resistant TB) comes from latent TB pool in our population.
But only 45% of newly diagnosed people living with HIV were
put on preventive TB therapy in 2019 in India. We have to
multiply our efforts to break the chain of TB transmission
as well as reduce risk for those with latent TB to progress
to active disease as far as possible if we are to end TB by
2025.

Globally, we had about 10 million new TB cases
in 2019 as per the latest WHO Global TB Report and over 1.5
million new people were infected with HIV in 2020. About 1.4
million people died of TB in 2019 and 680,000 people died of
AIDS related illnesses in 2020
worldwide.

Bobby Ramakant – CNS (Citizen News
Service)

(Bobby Ramakant is a World Health
Organization (WHO) Director General’s WNTD Awardee and
part of CNS (Citizen News Service) and Asha Parivar teams.
Follow him on Twitter @BobbyRamakant or visit www.bit.ly/BobbyRamakant)


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