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EPIDEMICS
Researchers unveil promising TB drug cocktail
by Staff Writers
Paris (AFP) July 23, 2012


Gates urges more tools, vaccine to end AIDS
Washington (AFP) July 23, 2012 - AIDS cannot be halted through treatment alone, and more prevention tools, in particular a vaccine, are needed to move seriously toward ending it, philanthropist Bill Gates said Monday.

While the Microsoft tycoon applauded efforts to get more people worldwide on antiretroviral drugs -- and said his foundation funds both research and care -- he noted more is needed to stamp out the deadly disease.

"No one should think that we have got the tools yet. We will get the tools but only if we stay the course in terms of the scientific investments," Gates told the International AIDS Conference in the US capital.

His Bill & Melinda Gates Foundation has committed more than $2.5 billion in HIV grants to organizations around the world, and has also committed more than $1.4 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Gates spoke to the conference, the world's largest gathering of AIDS scientists and advocates, as part of a panel on how to improve efficiency in funding of the three-decade-old disease that has killed 30 million people.

Gates said research toward a vaccine is "very exciting" but noted that even if a vaccine were introduced it would take time before the effects would be seen in the larger population.

"If you get a vaccine say in 10 years then the number of people you need to put on treatment is reduced in about 18 years," he said.

"Unfortunately there is this unbelievable lag time that comes out of that."

More than eight million people in low and middle income countries were on antiretroviral treatment in 2011 according to a UNAIDS report released last week, making up about half of those in need worldwide.

But Gates warned that no amount of funding can come up with enough money to treat everyone infected.

"It is clear that even if you take the most efficient way of doing this work -- the number of people who will eventually need to be on treatment, the amount of money we have is not enough to treat those people," he said.

"The world will make a decision how much those lives matter. And we are in a period of incredible uncertainty right now," he added.

"Just the uncertainty alone creates a certain instability."

Gates urged continued involvement by the AIDS community and reiterated the importance for nations and donors to support research, but also expressed support for ongoing treatment initiatives in the meantime.

"Now if somebody could cure AIDS -- which unfortunately that's very much a long shot," he said.

"There are people who are working it but... it is not in the cards at least any time soon, that is why this treatment imperative is so dramatic."

Researchers reported progress Monday with an experimental drug cocktail that killed a record 99 percent of TB bacteria in two weeks and costs a fraction of existing treatments.

It may also, crucially, be compatible with AIDS medicine.

While TB claims a life every 20 seconds, mainly in poor countries, more people are developing resistance to the existing arsenal of drugs that can take two years to work and often interacts badly with HIV antiretrovirals.

"The new drug combination killed more than 99 percent of the TB bacteria in the sputum of patients within two weeks of starting to take the drug," said Mel Spigelman, president of the Global Alliance for TB Drug Development.

The sputum test is an early indicator of how quickly a drug works, but further clinical tests are required to confirm that it does in fact cure TB, a lung disease that spreads through coughing and sneezing.

Spigelman and the research team said they were confident that further trials would confirm early, encouraging results for the three-drug combination called PaMZ.

The first tests with 85 patients suggested the drug could potentially cure people with ordinary TB and some forms of multi-drug resistance (MDR) "in as little as four months", Spigelman told journalists in a telephone conference.

"A new regimen like this could be reducing their (patients') treatment by up to two years or even more," he said, and "promises to be in the order of 90 percent cheaper than the current MDR regimen".

The new drug could reduce from 12,600 to 360 the number of pills an MDR-TB patient would need to take, and eliminate the need for injections.

About nine million people contract tuberculosis every year, and 1.4 million die.

TB is also the lead killer of people with AIDS.

Existing treatments can take anything from six months for "ordinary" TB, to 30 months for those with resistant strains which in some cases are becoming untreatable.

The PaMZ cocktail is in Phase II of clinical trials -- the first stage of human testing.

Early results were published Monday in The Lancet medical journal and presented at the International AIDS Conference in Washington.

The treatment was "well-tolerated and appeared safe", said the study, and seemed to be compatible with AIDS drugs.

The cocktail comprises a candidate TB drug called PA-824, the antibiotic moxifloxacin not yet approved for TB therapy, and an existing TB drug, pyrazinamide -- none of which patients have yet built up resistance to.

Patients can develop drug resistance when they fail to take their medicine as prescribed, but drug-resistant strains can also be directly transmitted from person to person.

PaMZ is being tested in two-month trials with 230 people in South Africa, Tanzania and Brazil -- a precursor to the final Phase III trials with more patients.

The researchers hope to start Phase III next year, but a lack of money may stand in their way.

"We do not have the financial resources to commence that (Phase III) trial," said Spigelman. "We are trying to drum up those resources from various donors."

Andreas Diacon, the trial's principal investigator from the University of Stellenbosch in Cape Town, said that if the testing went according to plan, the drug combination could be commercially available "within four to five years".

The number of MDR cases reported to the World Health Organisation have increased from 29,000 to 53,000 between 2008 and 2010, but the real number could be closer to 300,000, on some estimates.

Mario Raviglione, director of the World Health Organsiations' Stop TB Department, welcomed the findings of the trial which he called a "game-changer".

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