Tuberculosis control and AIDS

"The best way to stop the resurgent spread of tuberculosis is to cure TB patients", so concludes the Tuberculosis Technical Research and Advisory Committee of the World Health Organization (WHO). Traditional measures such as BCG vaccinations, mass screening and hospitalization (isolation) have been found to be only marginally effective in controlling the disease. Limited resources therefore, should be directed mainly towards curing patients and preventing them - through prompt and adequate chemotherapy- from infecting other people. Studies show that many programs cure less than half of patients, although potent regimens providing a 100 percent cure are available.

WHO warns that 30 million people will die from tuberculosis during the decade, and that the epidemic will worsen unless higher priority is given to fighting it. The disease is killing about three million adults a year worldwide, more than all other infectious diseases combined. In an alarming number of cases, TB bacteria have shown drug resistance. AIDS patients are said to provide TB bacillus with an ideal reservoir in which drug resistant forms easily mutate. In the United States, the number of cases has risen to 20 percent within eight years, notably due to infection of HIV-positive persons.

"TB is the world's most neglected health crisis," said Dr. Arata Kochi, director of the program at WHO. "How can we ignore a germ that already infects one in three people on the planet?" If assistance agencies increase spending on TB treatment programs to US$100 million a year from the estimated US$15 million at present, WHO estimates that 12 million deaths could be avoided in this decade.

Guidelines from the WHO recommend the addition of streptomycin to a core of isoniazid, rifampicin and pyrazinamide to prevent the emergence of drug resistant TB. All TB patients must be watched to be sure they take their medicine regularly, because universally, all TB patients are non-compliant. Even the doctors themselves, if they become TB patients, are shown to be non- compliant! To prescribe TB patients anti-tuberculosis drugs is just a simple matter. But the art of medicine is helping patients complete chemotherapy until they are cured.

Dr. HERMAN HARUN

Jakarta