TB treatment is bad. It’s hard on you. It’s hard on your family. It lasts six months. You have to take a cocktail of pills everyday for at least the first two months. The pills make you weak and unable to work. And that’s the most amicable treatment for regular TB. There also exist longer, more arduous treatments for MDR TB and XDR TB. Here I profile three cases of TB treatment which I’ve seen (The names have been changed to generic Spanish names to protect the patients).
Case 1: Susceptible TB
José started his treatment a month ago. Everyday he goes to his local health clinic down the street to take his pill-cocktail. He got diagnosed with TB when he was hospitalized because of the TB effects on his lungs. It had spread to his extrapleural tissue. Before he was hospitalized, he was working as a painter. He can’t work now, because the treatment makes him weak. More than that, ever since he started treatment, he has gotten a fever in the afternoon. He has tried numerous times to see a doctor about this, but he has yet to successfully see the hospital’s doctor. His wife cannot work, because she is nearly blind from glaucoma. His daughter is studying, but might have to drop out because they can’t afford to pay the fees for school.
Daily dose of TB drugs: Isoniazid, Rifampicin, Pyrazinamide and Ethambutol
Case 2: MDR TB
MDR TB is labeled as such because it is resistant to the two most common and effective first-line drugs: Isoniazid and Rifampicin. Patients with MDR have a treatment that lasts anywhere from 18-24 months. Juan has MDR TB. Before he was diagnosed with TB, he was a tour guide for the Paracas nature reserve. He has been receiving treatment for 6 months. Which consists of daily injections of the second-line TB drugs. He has got injections in his legs, his butt, and now he is getting them in his arm. He has had several negative TB tests, and he hopes to change treatment from receiving shots to taking pills. He says he doesn’t mind the shots (although the way he says it makes me question if he’s telling the truth), but the dolorous side effects causing his legs to feel heavy and immobile is what he can’t stand. But in order to be approved to leave treatment, he needs a doctor’s approval, and he has been waiting all month for his appointment, which he has this week. There is no guarantee that the doctor will say he can change his treatment. If he has to continue with the shots, he might abandon treatment.
Case 3: XDR TB
XDR TB, extremely drug resistant TB, is resistant to Isoniazid and Rifampicin, as well as several second-line drugs. The cure rate for XDR is much lower than MDR, but it is still curable in some cases and treatable in all. Miguel has XDR TB. He has been in chemotherapy treatment for his TB for the last five years. And he is still not cured. The drugs are fighting the TB, but they can’t kill it. He is weak and in a wheelchair–more so because of the drugs than the TB. He is mostly deaf, and has communicates by writing. All these side effects are because his TB is resistant to the drugs with fewer side effects. He had know choice but to take these damaging drugs. His mother takes care of him, and for now, the government is still providing treatment for his TB.
I tried as best I could to represent these cases as I see them. I try not to make them worse than there are, and I do not want them to be looked at as pity cases, but rather a snapshot of reality for three people with TB here in Peru.
Why aren’t there better drugs?
Well, TB is particularly tricky disease, different from normal bacterial infections so simple bacterial drugs don’t work. If you want some more in depth biology, check out the wikipedia page. But also, Tuberculosis is largely a disease of the poor. In the past, there had been little research money dedicated to the disease, because who would pay for the better drugs that can cure TB faster with less side effects? In recent years, partly because of PIH, TB has started to get more publicity. There is now a greater push from organizations such as TB Alliance.
Also interesting is perhaps the most important discovery I’ve ever seen: A self-replicating synthetic DNA cell. This may not mean too much to you non-science folk, but I think with this achievement, the possibility for vaccine development is wide open. We can now explore the possibilities of developing a vaccine that evolve to combat a constantly-mutating disease, such as TB.
