Tuberculosis: A Resilient Killer

The tuberculosis bacterium is a nasty organism to deal with.  It has all sorts of tricks, like having a very thick outer coating that enables it to survive inside the body for long periods of time.  Tuberculosis has also developed the ability to resist drugs that are typically used against it. 

The bacterium is causing an annual global burden of twelve billion [1] while infecting one third of the world’s population [2].  A population that is especially threatened by tuberculosis is HIV positive people; for them, developing tuberculosis is a much higher possibility than if they were HIV negative.  In fact, research indicates that HIV and TB facilitate each other’s attack on our immune system.  Interestingly, in HIV positive people, multi-drug-resistant tuberculosis (MDR-TB) is twice as common than in HIV negative people [3]. 

These observations indicate that HIV and TB must be addressed together, and that MDR-TB among HIV positive persons is a significant emerging issue.  I would like to base my paper on the topic of MDR-TB in HIV positive persons.   

I find this topic interesting because of so many factors that contribute to tuberculosis and the emergence of MDR-TB.  Tuberculosis and poverty form a cycle of disaster.  Because poverty correlates with hunger, lack of sanitation and poor housing conditions, poverty forms a friendly breeding ground for tuberculosis.  Tuberculosis then worsens the situation by decreasing people’s capacity to work, makes them poorer due to expensive treatments, and generally exacerbates poverty. 

It is also interesting that poverty correlates with high incidence of HIV in inner cities.  So it would be possible that the topic can be focused on MDR-TB in HIV positive persons in inner cities.   

I think this is an important topic to investigate because biomedical research still has to make major improvements in the realm of MDR-TB and effective tuberculosis vaccinations.  MDR-TB is something that would only be exacerbated if treated with more drugs, so the most effective approach would be a public health approach.  There are some novel ideas coming out from research, like using antimicrobial pigments from Antarctic bacteria to treat TB, but that could take years to develop and test. 

I hypothesize that by focusing on MDR-TB in HIV positive persons, we can tailor MDR-TB or TB prevention programs specifically to HIV positive persons.  By using models from various existing inner-city programs that work, MDR-TB/TB prevention programs for HIV positive persons can be targeted to HIV positive persons living in inner cities. 

I am already eying Partners in Health and their community-based programs in Boston as a good source of information, and certainly a model to consider. 

[1] http://www.who.int/trade/distance_learning/gpgh/gpgh3/en/index7.html

[2] http://www.who.int/mediacentre/factsheets/fs104/en/

[3] http://www.unaids.org/en/KnowledgeCentre/Resources/FeatureStories/archive/2008/20080227_MDR_rprt_for_UNAIDS.asp