TUBERCULOSIS
– SCI & TECH
News:
Will generic supply of
bedaquiline be accessible?
What's
in the news?
● Bedaquiline
has now become the cornerstone to cure drug-resistant tuberculosis (DR-TB).
Key
takeaways:
● Last
week, a major barrier for drug resistant TB care ended, when Johnson &
Johnson’s patent on bedaquiline expired.
● This
long-awaited expiry will allow generic manufacturers to supply the drug, but
J&J appears intent on maintaining its monopoly over the bedaquiline market.
Tuberculosis:
Backdrop:
● Worldwide,
tuberculosis (TB) has surpassed HIV-AIDS as the leading cause of death due to
infectious diseases.
● India
had a little less than 20 percent of the world’s population, but had more than
25 percent of the total TB patients of the world.
● India, the TB capital of the world,
the disease kills 1,400 persons every day.
Infection:
● Tuberculosis
(TB) is an infectious disease caused by Mycobacterium tuberculosis.
● TB
commonly affects the lungs (pulmonary
TB) but can also affect other parts
(extrapulmonary TB).
● Pulmonary
tuberculosis is a chronic consumptive disease, but it can be present as acute
pneumonia.
● Pneumonia
is an inflammatory condition of the lung affecting primarily the microscopic
air sacs known as alveoli.
● Tuberculosis
spreads from person to person through the air, when people who are infected
with TB infection cough, sneeze or otherwise transmit respiratory fluids
through the air.
● Most
infections do not have symptoms, known as latent tuberculosis.
● About
10% of latent infections eventually
progresses to active disease which, if left untreated, kills about half of
those infected.
● HIV
infection, diabetes, undernutrition, lung damage due to pollution, tobacco
smoking, fall in immune functions due to chronic diseases, alcoholism, etc.
were the main trigger causes behind it.
What
is drug-resistant TB?
● As
of 2017, India accounted for around one-fourth of the world’s burden of
multi-drug-resistant (MDR) TB and of extensively-drug-resistant (XDR) TB.
MDR
TB:
● MDR
TB resists treatment by at least isoniazid
and rifampicin, the two frontline drugs in TB treatment.
XDR
TB:
● XDR
TB resists these two drugs as well as fluoroquinolones
and any second-line injectable drug.
● XDR
TB is rarer than MDR TB - there were 1,24,000 cases of the latter in India
(2021) versus 2,650 cases of the former (2019).
Concerns
in India:
● TB
incidence in India has been on the decline, but MDR TB and XDR TB endanger
initiatives to locally eradicate the disease.
● During
the COVID-19 pandemic, there were
indications that TB treatment was hit by disrupted supply chains, availability
of healthcare workers for non-pandemic work, and access to drug-distribution
centres.
● A
peer-reviewed 2020 study reported that TB becomes isoniazid-resistant when a
person doesn’t fully adhere to the treatment regimen whereas
rifampicin-resistance emerges due to other factors.
● It
also found that the incidence of MDR TB (i.e. resistance to both drugs) was
“strongly correlated with treatment
failure and spread through contact, and not to treatment compliance”.
How
is drug-resistant TB treated?
● TB
is an infection of the bacterium Mycobacterium tuberculosis in the lungs, but
often in other organs as well. It can be treated by strictly adhering to the
doses and frequencies of drugs prescribed by a physician.
● Drug-resistant
TB is harder to treat. One important option for those diagnosed with pulmonary
MDR TB is bedaquiline.
● In
2018, the World Health Organization replaced two injectable drugs for MDR TB
with an oral regimen that included bedaquiline.
Revised
National TB Control Programme (National TB elimination program):
RNTCP
incorporates the principles of directly
observed treatment-short course (DOTS). DOTS is a systematic strategy which
has five components:
1.
Political and administrative commitment: Since TB can be cured
and the epidemic reversed, it warrants the topmost priority, which has been
accorded by the Government of India.
2.
Good quality diagnosis: Good quality microscopy allows
health workers to see the tubercle bacilli and diagnose properly.
3.
Good quality drugs: An uninterrupted supply of good quality
anti-TB drugs must be available. RNTCP provides a box of medication for the
entire treatment for every person registered.
4.
Supervised treatment to ensure the right treatment: The
RNTCP uses the best anti-TB medications available in a right way.
5.
Systematic monitoring and accountability: Standard
recording and reporting system, and the technique of cohort analyses are used
to keep an account of every person treated.
● According
to the United Nations Sustainable Development Goals, all nations have set the
goal of eradicating TB by the year 2030.
● End TB strategy:
India is committed to eliminating tuberculosis from the country by 2025, five years ahead of the global
target by the World Health Organisation (WHO) i.e. 2030.
● Elimination
as defined by the World Health Organisation (WHO), means that there should be
less than 1 person with TB for a population of a million people.