Hyderabad: Diagnosis of latent tuberculosis is not a priority in India and the decision of Central Drugs Standard Control Organisation (CDSCO) to import Refapentine drug to treat it is being viewed cynically.
Latent TB is the presence of mycobacterium in small numbers in the body. These are controlled by the immune system and there are no symptoms.
Clinical trials of the drug will be carried out on the local population to ascertain the drug’s benefits. The drug was approved two years ago in the West and is used in the US as it does not have active tuberculosis. The World Health Organisation has included the drug in the list of essential medicines.
“Latent tuberculosis drugs work where the population does not have a high incidence of active tuberculosis,” said Dr Subakar Kandi, senior professor of pulmonology. “In India, 50 per cent of the population suffer from the mycobacterium infection and six per cent have active disease. The latent tuberculosis drugs will be required at the public health-level once we are able to bring down incidence of active TB. Latent tuberculosis, presently, is ruled out at the hospital-level in patients who are going to undergo transplants. In these cases, too, the doctors have to first rule out active tuberculosis. This is done because the patients are put on immunosuppressants after transplants. These are specific groups where the latent tuberculosis is presently evaluated. The drugs are given to them based on the results.”
According to public health officials, the main challenge would be to control active infection of the disease. A senior public health official in the TB programme said, “Our main concern is the missing million cases that are spreading the bacteria to at least 10 to 15 more people before they die of the disease. This is the biggest worry at the public heath level.”
“Misdiagnosis and improper diagnosis are still a major problem in the case of tuberculosis,” said Dr Mehboob Khan, superintendent of Chest Hospital. “Reduction in active tuberculosis requires a focus where compliance levels have to be improved. The efforts taken by the government and incentives provided for opting for the treatment helps but it requires an active community participation to push it to the next-level.”
A random survey carried out by pulmonologists in India found that 0.1 per cent physicians were interested in diagnosing latent tuberculosis. Hence, talk of clinical trials among Indians is being viewed with scepticism.
“The phase of tackling latent tuberculosis will come at a much later stage in India,” said a senior health professional. “We are nowhere close to it at present. There are two tests which have to be carried out to rule out LT. Skin and blood test has to be done and the drug has to be taken for three months. We need to rethink how this will benefit apart from the aspect of research and compatibility in the chosen Indian population.”
