NIAID Describes Research Priorities to Fight Drug-Resistant Tuberculosis (4/24/2008)

Tuberculosis (TB) has long been one of the world's great killers. Now, forms of drug-resistant TB-multidrug (MDR) and extensively drug-resistant (XDR)-are occurring at an ominous and accelerating rate. To help in the fight against drug-resistant TB, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, has formulated an MDR and XDR TB research agenda.

A summary of the agenda, authored by NIAID Director Anthony S. Fauci, M.D., and members of the NIAID Tuberculosis Working Group, is now available online in The Journal of Infectious Diseases.

"The TB diagnostic tools in use today are antiquated, slow and insensitive; TB drug regimens are complex and lengthy; and the only vaccine available does not provide effective protection against adult pulmonary TB," says Dr. Fauci. "The challenge of TB control is further compounded by the rise of drug-resistant TB, and we anticipate that the NIAID Research Agenda for Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis will contribute substantively to the fight against this emerging threat."

The World Health Organization (WHO) estimates that 500,000 people worldwide have MDR TB, while the frequently fatal XDR TB has been detected in 46 countries. Factors contributing to the rising tide of drug-resistant TB include

• Lack of routine testing to determine TB drug-sensitivity
• Incomplete treatment of people infected with TB-causing bacteria
• The epidemic of TB in HIV-infected people
• Limited TB research by pharmaceutical companies, resulting in few new anti-TB drugs or other interventions

The NIAID research agenda complements domestic and international efforts to prevent and control the spread of MDR and XDR TB. Whereas the WHO's STOP TB Partnership plan emphasizes increased surveillance and control and treatment efforts, the NIAID agenda focuses on biomedical research. The Institute also collaborates with the Centers for Disease Control and Prevention and other NIH Institutes and Centers on TB research efforts in the United States.

To prevent the further emergence and spread of MDR and XDR TB, the NIAID agenda identifies areas of biomedical research that are likely to contribute substantially to a global public health response. Building on existing efforts within the international network of TB research, NIAID's priorities include efforts to