Christine F. Sizemore, Ph.D., Richard E. Hafner, M.D., and Anthony S. Fauci, M.D., National Institute of Allergy and Infectious Diseases, National Institutes of Health
The theme of World TB Day 2012, Eliminate TB in My Lifetime, boldly challenges us to improve and expand tuberculosis (TB) control and related research efforts that recently have led to slowly declining rates of illness and death from this ancient disease. Even with the technological advances available in the early part of the 21st century, the elimination of TB will be an enormous task. TB claimed 1.45 million lives worldwide in 2010, according to the World Health Organization. An estimated one-third of the world’s population is latently infected with the bacterium that causes TB, meaning they experience no symptoms but are at risk for developing active disease. Among people with HIV/AIDS, TB is a major co-infection and the leading cause of death, responsible for killing approximately 350,000 HIV-infected individuals in 2010. The interface of the TB and HIV epidemics and the continuing emergence of drug-resistant TB are serious threats to achieving TB control worldwide. Although recent progress against the disease is heartening, the control and eventual elimination of TB will require a long-term, multifaceted commitment from the global health and research communities.
TB control and the care of TB-infected people are being improved by making existing TB interventions more accessible and affordable, as well as simpler to administer. Comprehensive TB control can be markedly enhanced, however, with better medical tools. To transform the field, we must address long-standing challenges in TB research, such as identifying the factors involved in the immune control of latent TB infection that allow 90 percent of otherwise healthy TB-infected individuals to never develop active disease. We need to use novel scientific tools and apply modern approaches to answer this and other fundamental questions. High-throughput sequencing, for example, can efficiently analyze the genomes of drug-sensitive and drug-resistant TB strains and help us to identify genetic markers useful for developing tests to quickly detect resistance to anti-TB drugs. A systems biology approach helps us make sense of the complex networks of biological responses in the TB bacterium on the part of the human host so we can better understand the disease and give direction to vaccine and drug discovery projects. In this regard, a renewed focus on fundamental TB research will enable us to refine our strategies for developing and applying innovative interventions against TB. To this end, the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health leads the U.S. government’s biomedical research effort in TB and supports scientists worldwide engaged in these efforts.
An important milestone in modernizing TB control was the WHO Global Tuberculosis Control Report 2011, which for the first time included biomedical research as a critical component of the global fight against TB. Integrating biomedical research into the framework of global TB control is an essential component of the WHO report as well as other recent strategic documents developed by the TB research community, including An International Roadmap for Tuberculosis Research and the updated Strategic Blueprint for TB vaccines. These collaborative efforts to identify gaps and opportunities in biomedical research are critical for developing new interventions and control strategies.
Integral to these efforts, NIAID also is increasing TB clinical research capacity for adults and children with and without HIV co-infection through its existing international HIV/AIDS clinical trials networks. Recent results from two clinical trials sponsored by the Institute have advanced the management of HIV and TB co-infection by defining the optimal time to initiate antiretroviral treatment in relationship to TB therapy. Several NIAID-funded clinical research sites in Africa recently joined other collaborators in an ongoing clinical trial testing an investigational TB vaccine in infants at risk for TB infection. These networks and other NIAID resources are helping to dramatically improve the efficiency of drug and vaccine development and systematically advance the current pipeline of potential TB diagnostics and interventions into clinical application. As part of our emphasis on clinical research, NIAID is supporting multiple efforts and partnerships focused on the discovery of novel biomarkers to rapidly assess the status of infection, response to treatment and protective immunity.
Eliminating TB in a generation, while an ambitious goal, can become a reality through the continued commitment and collaboration of the key stakeholders in biomedical research and global health. To date, these efforts have provided the knowledge and novel methodologies to develop a robust pipeline of new TB countermeasures. Fostering even closer integration of biomedical research with the TB control community will help assure that new medical tools are applied in the most effective manner to make TB a disease of the past.
Anthony S. Fauci, M.D., is director of NIAID. Richard E. Hafner, M.D., is acting chief of the TB Clinical Research Branch in the NIAID Division of AIDS; Christine F. Sizemore, Ph.D., is chief of the Tuberculosis and Other Mycobacterial Diseases Section in the NIAID Division of Microbiology and Infectious Diseases.
NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov/.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.