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The future of TB care

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On World Tuberculosis Day, we review the latest advancements aiding disease management and care.

Tuberculosis (TB) is one of the leading causes of death and morbidity across the world. The bacillus Mycobacterium tuberculosis (Mtb) causes tuberculosis, which is disseminated by aerosol droplets. Mtb infection causes an immune response in around one out of every four persons globally, which can be latent or develop into active disease manifestations. Patients with tuberculosis who have no active signs or symptoms of the disease were initially diagnosed as having latent tuberculosis, which has now been modified to tuberculosis infection. Invest to End TB - Save Lives is the theme of World TB Day 2022. It emphasises the critical need to increase resources to scale up the battle against tuberculosis and meet global leaders' promises to eradicate the disease. This is especially important given the many crises such as the COVID-19 pandemic, that have jeopardised progress toward TB eradication.

Patients with tuberculosis have a 5–10 per cent chance of acquiring TB illness. This rises to a 16 per cent yearly risk of activation where TB infection transforms into TB disease in HIV patients across various levels of immunodeficiency. In 2019, an estimated 10 million new incident cases of active tuberculosis illness were reported worldwide.

Two-thirds of all cases occur in a number of countries, a majority of which have overburdened health systems with little resources. The World Health Organisation (WHO) recognised the tremendous global burden of illness when it established the End TB project in 2016. Through innovative research and education, they aim to minimise the disease's incidence, morbidity, and mortality by improving diagnostic and treatment procedures, as well as establishing prevention initiatives. By 2035, the objective is to reduce tuberculosis mortality by 95 per cent and the global incidence of tuberculosis by 90 per cent. It is projected that 60 million lives have been saved globally in the 21st century as a result of the continuous efforts.

Given the present incidence of tuberculosis infection and the lifelong risk of advancing to active illness, it is critical to safeguard future generations from this burden by completely ceasing transmission. Scientists have identified several possible candidates for vaccination based on a better knowledge of the cellular mechanisms involved in Mtb susceptibility and development. The cellular immune response is crucial to this, with an emphasis on increasing T-helper cell (TH1) responses while decreasing TH2 and regulatory T-cell responses. Mtb appears to have recognised the need to adapt to this hypo-inflammatory phenotype as well, with more recent strains exhibiting shorter latency and higher virulence than previously documented.

The only globally authorised TB vaccine is bacillus Calmette–Guérin (BCG), which successfully reduces the risk of severe paediatric TB illness with an 85 per cent decrease in TB meningitis and miliary TB in individuals that are 10 years of age.

Moving forward, it is anticipated that each patient will have a personalised approach to TB therapy due to a mix of new medications, revised durations, and more effective assessment of response to treatment. Healthcare providers will be able to construct a treatment combination and duration with more precision for each patient. Research such as PredictTB attempts to identify biomarkers and radiographic appearances that indicate response and chance of recurrence. In early-stage clinical trials, similar technologies may potentially aid in the development of more effective medications. Furthermore, any new medicine or technology created must be inexpensive and accessible to all institutions, particularly hospitals in low-resource settings, where most of the worldwide TB burden persists.

The future of tuberculosis therapy seems promising. There is now a global effort being made to discover innovative technology and treatments for tuberculosis patients. By combining these advances, there is possibility to base each patient’s treatment on their unique protein biosignatures. This is in conjunction with the genomic expression of mutations in the Mtb strain that they have been infected with.

To reach the objective of worldwide TB eradication, collaboration through sharing expertise on a global scale can help guarantee that each patient receives the necessary therapy and support to overcome their TB diagnosis with reduced morbidity.

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