Applying the HIV Treatment Model to TB

Long-acting injectables for latent and active tuberculous (TB) might be a treatment option in the future and could open up the door to possibly bundling HIV and TB care together.

The incidence rate of TB is much higher in developing countries than here in the United States. In the US, the TB rate declined slightly (-2.3%) from 2016 to 2017 with approximately 2.8 cases per 100,000 persons, according to the Centers for Disease Control and Prevention (CDC).

In addition, the agency also reports that up to 13 million people have Latent TB Infection (LTBI) in the US and that between 5% to 10% of people with LTBI will progress to infectious TB.

Worldwide, up to 25% of the world might be infected with LTBI.

Whether it be latent or acute TB, challenges remain in terms of treatment. One idea to aid in care is to take the HIV treatment approach of long-acting injectables and potentially apply that model to TB.

“We are starting to see a real sea change in HIV with long-acting injectable formulations, and I’m hopeful that will catalyze a similar progress in research and development in TB,” Eric Nuermberger, MD, associate professor of Medicine and International Health at Johns Hopkins University, stated. “I think what it has demonstrated is that there are at least segments of the patient population that prefer to take intermittent treatment on a monthly or a 2-month basis as opposed to daily pills. I think that could translate to TB therapy as well as it does to HIV therapy.”

Nuermberger presented at a symposium at CROI recently on “The Potential of Long-Acting Injectable Drugs for Prevention and Treatment for TB.”

And in the patient populations who are dealing with both TB and HIV, Nuermberger says you could potentially bundle treatment together.

“Using a very similar clinical infrastructure could really help to disseminate TB therapy to the places that it is needed and the patients who are at significant risk—namely people who are being treated at clinics for HIV.”

Long-acting injectables might be attractive to patients for a few reasons including adherence, absence of pill fatigue, and patient privacy which can help with the removal of social stigma.

Contagion spoke to Nuermberger about how other patient populations might benefit from this method of drug delivery, an example of HIV treatment and TB prevention care, and how long-acting injectables could lessen the number of initial patient encounters in acute TB care, yet help with therapy adherence.