Tuberculosis (TB) is a curable and preventable disease which is often considered to be a disease of poverty. Worldwide, TB is the leading cause of mortality from an infectious disease, surpassing HIV infection. Globally, the burden of disease is decreasing, but it remains high. In 2015, an estimated 10.4 million people developed TB and 1.8 million died from TB, including 400,000 from HIV-associated TB. Furthermore, one quarter of the world’s population is estimated to be infected with Mycobacterium tuberculosis, although active disease has not yet developed. Several conditions – such as diabetes mellitus, malnutrition, and smoking – are known to increase the risk of progressing from latent M. tuberculosis infection to active TB. HIV-induced immunodeficiency is by far the most important risk factor. Standard anti-TB drugs have been successfully used for decades to cure TB.
Almost half of TB cases remain undiagnosed, contributing to the transmission of TB. Particularly in low- and middle-income countries where HIV prevalence is high, TB accounts for approximately 40% of adult deaths, and in almost half of these cases the disease remains undiagnosed until death. More efforts are needed to increase diagnostic capability so that TB can be diagnosed at an early stage.
Another issue – drug resistance – has a major impact on the success of TB treatment. First-line treatment is highly effective in drug-susceptible TB, but treatment of MDR/XDR TB requires the use of second-line drugs that are less effective, more expensive, less widely available, and can have severe side effects. Drug resistance to first-line drugs is growing and is an emerging public health problem.
We use routinely collected data on HIV-positive patients from large ART databases such as IeDEA Southern Africa, but also conduct dedicated field molecular epidemiological studies. Our research team collaborates with national and international researchers as well as field partners in sub-Saharan Africa.
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