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October 14, 2008
An international effort led by physician-scientists at Johns Hopkins to control the global spread of HIV-related tuberculosis and treat the dual epidemics in hardest-hit countries has received $32 million in additional funding from the Bill & Melinda Gates Foundation.
Officials of the Seattle-based foundation and Johns Hopkins announced the award today in Paris in advance of this week’s 2008 World Conference on Lung Health and the International Union Against Tuberculosis and Lung Disease.
The new support for the Hopkins-based Consortium to Respond Effectively to the AIDS/TB Epidemic, or CREATE, complements the $44.7 million given by the Gates Foundation in 2004 to start the initiative, considered the largest TB-related research effort in the world. More than 250 researchers and dozens of health policy experts in Africa, South America, Europe and the United States are part of the effort.
CREATE currently sponsors three major clinical trials in South Africa, Brazil and Zambia on the use of antibiotic therapy to prevent TB and how actively screening people for the disease can be used to prevent its spread in communities where HIV is epidemic. A major goal for researchers is to use the studies as evidence for reforming public health worldwide to promote a stronger implementation of TB prevention policies.
Hopkins infectious disease specialist Richard Chaisson, M.D., who leads CREATE, says the added resources come at “a pivotal juncture, just as our team’s research is making serious progress,” in finding drug therapies that prevent people from becoming infected with Mycobacterium tuberculosis in the first place.
Preliminary survey findings last year from the CREATE study in Rio de Janeiro offered the first evidence that combination antiretroviral therapy with the antibiotic isoniazid could confer the best chance of preventing active TB disease in people co-infected with HIV and TB.
American and Brazilian researchers found that isoniazid with highly active antiretroviral therapy (HAART) is more effective than either therapy on its own. Among those treated with both drugs, the risk of developing TB disease was reduced by 80 percent. Isoniazid on its own reduced the frequency of disease from the highly contagious tubercle bacillus by 32 percent. Scientists have known for years that HAART on its own reduced the risk of TB, by 51 percent in this survey, but they did not know until now the drugs’ combined effects.
“This boost in research funding is a major vote of confidence in our team’s efforts to deliver innovative public health strategies designed to help people suffering from the deadly twin epidemics of TB and HIV,” says Chaisson, a professor of medicine, epidemiology and international health at the Johns Hopkins University School of Medicine.
“TB is now the leading killer of people with HIV worldwide,” he says. “Because HIV weakens the immune system, people with HIV are especially vulnerable to TB, and TB rates have increased significantly in countries with high HIV prevalence. We are testing simple interventions at the community level that can reverse these deadly trends.”
Chaisson notes that worldwide, each year, nearly 9 million new cases of TB are diagnosed, and more than 1.5 million people die from the disease. In sub-Saharan Africa, one-quarter of the estimated 1.6 million deaths caused by TB annually occur among people living with HIV/AIDS.
The World Health Organization (W.H.O.) estimates that 1 billion people worldwide will be infected with tuberculosis by the year 2020, of whom 200 million will fall ill and 35 million will die.
Other organizations collaborating with CREATE on the studies in South Africa, Brazil and Zambia are the London School of Hygiene and Tropical Medicine, the Desmond Tutu Tuberculosis Centre at the University of Stellenbosh, the Rio de Janeiro Municipal Health Secretariat, the Aurum Institute for Health Research, the Zambia AIDS-related TB Project, and W.H.O.
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