Abstract:
Tuberculosis (TB) control is severely hampered by the emerging threat of drug resistance.
BCG, although the most widely used vaccine, has no impact on the global TB epidemic.
Only few novel drugs have become available, and most of the treatment components consist of repurposed drugs (new generation quinolones, linezolid and clofazimine).
Two of the injectable agents have recently been withdrawn because of their associated risk of poor outcome.
Many patients in highly burdened settings drop out because of the toxicity and long duration of 2nd line drug treatment.
Many patients with drug-resistant TB go undetected and continue to spread resistant bacilli in the community.
An overview will be presented of:
· the current evidence to treat drug-resistant TB;
· the issue of drug exposure to individualize treatment based on an algorithm that includes therapeutic drug monitoring;
· the potential to fine tune treatment based on pharmacokinetic and pharmacodynamic modeling; and
· the potential of host targeted treatment components,
· attempts to prevent sequelae including
· early case finding and
· prevention of scar formation, as well as
· therapeutic vaccination.
A recent break-through opening the way to develop biomarkers as surrogate endpoints to speed up vaccine development will be discussed.
The need to collaborate between all stake holders including public health, microbiologists, public and private care providers and drug providers will be addressed, as well as the need to integrate management for co-infections with HIV and hepatitis B/C.
Finally, knowledge gaps to improve treatment outcome will be addressed.
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Biography:
Tjip van der Werf was born in Amsterdam, 20th March, 1954.
In 1972, he completed high school (Gymnasium bèta, Harderwijk) and moved to Groningen for further studies. He started studying Law; in 1973, he started in the Medical School. At the University of Groningen, he obtained his Bachelors’ degree in Law in 1975, and after an elective period in malaria research, Fudumi, Western Province, Kenya he obtained his medical degree (MD) in 1980.
After 2-yr rotations in Medicine, Surgery and Obstetrics in Groningen, he trained at the Dutch National course in Tropical Medicine (NTA) in Amsterdam in 1982; after additional language and socio-cultural training courses at the Dutch Reformed Missionary Training Centre (HKI) in Oegstgeest, he worked as a Medical Officer 1983-1987 in Agogo Presbyterian Hospital, Ghana. Ending 1987-1992, he trained in Pulmonary Medicine (Isala Klinieken; from 1990, University Hospital, Groningen) as a resident. In 1991, he defended his PhD Thesis on Tuberculosis and Buruli ulcer studies in Ghana.
In 1992, he was Board certified as Chest Physician, and became a member of staff at the Medical ICU of the University Medical Center Groningen. In 1997 he obtained his Board registration as Physician in Critical Care Medicine. Between 1998- 2003 he acted as a member on the Curriculum committee, Gemeenschappelijke Intensivisten Commissie (GIC), and between 2001 – 2005, he represented NVALT (Dutch Chest Physicians) as a member in the GIC. From 2001, when an NWO Research Grant (Ymkje Stienstra, PhD student) was obtained, his research activities shifted back to Buruli ulcer; in 2005, with a larger Research Grant EU (FP6 INCO-Dev2-015476) was obtained, he moved out of ICU and was appointed as Professor of Medicine, University Medical Center Groningen and Groningen University; he has chaired the Committee for Hospital Infections, UMCG; and has chaired as head of Infectious Diseases; he has also led the research activities in the Tuberculosis Unit as a member of staff of the Department of Pulmonary Medicine & Tuberculosis in the UMCG.
Current research activities encompass primarily Buruli ulcer research, predominantly focusing on
Improving antimicrobial therapy. In 2010, a second EU grant (BURULIVAC FP7, no 223328 – Work Package ‘Ethics’ guiding conduct of clinical trials) was obtained. Since 2010, he has chaired the Drug Treatment Working Group; and he has served as a member of the Technical Advisory Group, WHO Program on Neglected Tropical Diseases, Global Buruli ulcer Initiative, WHO. In 2011, he became the Principal Investigator of a WHO-sponsored trial for oral antimicrobial treatment for Buruli ulcer, Benin and Ghana. Seven PhD students completed their work including 2 PhD students from Africa (Benin, Ghana) while work of two more PhD students is in progress.
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