The new TB drug bedaquiline has shown impressive results in trials so far. Picture: 123RF/VIKTOR GRADOW
The new TB drug bedaquiline has shown impressive results in trials so far. Picture: 123RF/VIKTOR GRADOW

A short course of antibiotics for people with latent tuberculosis could prove to be the most effective way of stopping the spread of the disease, since there is currently no effective vaccine, says a report published by the Lancet on Thursday.

TB is the world’s biggest infectious killer, felling 1.6-million people in 2017. In SA, its spread has been fuelled by HIV, which makes people more vulnerable to infection. SA had the world’s second highest TB infection rate in 2017, with about 567 cases per 100,000 population. About 132,000 people were newly infected, and 78,000 people died from TB in SA, according to the World Health Organisation (WHO).

“Our failure to implement TB prevention strategies is one of the key reasons we still have not made enough progress against TB,” said Gavin Churchyard, CEO of the Aurum Institute in Johannesburg, and one of the authors of the report released by the Lancet Commission on TB.

“Unless we quickly tackle the seedbed of the epidemic — latent TB infection — we stand no chance of removing this health hazard from impoverished communities around the world,” he said.

The WHO estimates that about a quarter of the world’s population has latent TB infection and that they have a lifetime risk of between 5% and 15% of falling ill from the disease. However, vulnerable groups, such as people living with HIV, are at much greater risk of developing active TB. They are between 20 and 37 times more likely to develop the disease than people who do not have a compromised immune system.

 Regina Osih , the Aurum Institute’s senior technical expert on HIV/TB, said the standard treatment for latent TB had not proved effective as many patients did not finish their course of daily isoniazid pills, and too little attention had been paid to tackling potential infection among their close contacts. Isoniazid preventive therapy is at least six-months long.

But a new treatment called 3HP offers hope of a shorter and more effective treatment, she said. 3HP combines isoniazid and rifapentine, is taken just once a week for three months, and is safe to take with most HIV treatments, Osih said.

The report also highlighted the need for other strategies to tackle TB, and called for global investments in research and development funding to increase from $772m per year in 2017 to at least $2bn per year through to 2022.