Will Arikace be used to treat Tuberculosis next year?
Following on from my suggestion yesterday that it isn't easy to tell the difference between NTM infection and TB, those here who are interested in firsthand accounts from physicians who are qualified to treat humans might be interested in searching for the following report -
Human infections due to Mycobacterium lentiflavum: first report in Iran
Of particular relevance to the likelihood that Arikace will be used next year to treat patients infected with Mycobacterium Tuberculosis is the comparison between how the patient was being treated when MDR-TB was suspected, and how she was treated after the NTM infection was diagnosed.
Physicians won't see Arikace as a potential therapy for NTM infection but as a potential therapy for Mycobacterial infection.
For those who couldn't be bothered to take a look at that case study from Iran, the therapeutic regimen when the patient was suspected of having MDR-TB included amikacin. The new therapeutic regimen after NTM infection had been diagnosed also included amikacin.
When I was banging on recently about the potential for the use of Arikace in controlling the current MDR-TB epidemic in China (given that the Chinese government is currently throwing tens of billions of dollars into healthcare) I suggested that the MDR-TB epidemic could be a consequence of an HIV epidemic the Chinese don't want to talk about.
It seems to me that a therapy which swiftly delivers an effective concentration of amikacin to the lungs without the potential of interaction with antiretroviral drugs in the bloodstream would be particularly well suited to pulmonary mycobacterial infection in people with HIV. The following study confirms that HIV / Mycobacterial co-infection is indeed a factor. It doesn't give us numbers for the problem nationwide, but 110,000 Chinese are estimated to be suffering from MDR-TB -
"Mycobacterium tuberculosis and non-tuberculous mycobacteria isolates from HIV-infected patients in Guangxi, China.
Lan R, Yang C, Lan L, Ou J, Qiao K, Liu F, Gao Q.
Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi, China.
Tuberculosis (TB) remains the leading cause of death among human immunodeficiency virus (HIV) infected persons. The prevalence of infection with Mycobacterium tuberculosis and non-tuberculous mycobacteria (NTM) in HIV-infected patients in China is unknown.
To estimate the prevalence of M. tuberculosis and NTM in HIV-infected patients in Guangxi Province, determine their drug resistance profiles, and evaluate the genotype patterns of M. tuberculosis strains.
Samples were collected from two HIV designated hospitals in Guangxi Province between 2005 and 2008. HIV-infected patients who were culture-positive for mycobacteria were included. Drug susceptibility testing was performed for mycobacterial isolates. NTM species was identified by sequencing, and M. tuberculosis isolates were genotyped using the variable number of tandem repeats method.
M. tuberculosis and NTM were identified in respectively 117 (53%) and 102 (47%) HIV-infected patients. Drug resistance was found in 27% and multi-drug-resistant TB (MDR-TB) in 11% of the patients with TB. Previous treatment for TB was significantly associated with MDR-TB. Twenty (17%) TB patients belonged to eight VNTR-defined clusters.
The high frequency of NTM among HIV-infected patients raises concerns about accurate species identification before the determination of appropriate treatment. The potential for TB transmission exists among HIV-infected patients. Intensified screening and effective treatment of TB-HIV co-infected patients is urgently needed."