Zeitschrift für Zellwissenschaft und Therapie
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Challenges of Tuberculosis Treatment with DOTS: An Immune Impairment Perspective

Sultan Tousif, Shaheer Ahmad, Kuhulika Bhalla, Prashini Moodley and Gobardhan Das

The World Health Organization (WHO) estimates that the causative agent of tuberculosis (TB) currently infects one third of the global population and is responsible for about 2 million deaths among those infected annually. Current therapy for TB consists of multiple expensive antibiotics (Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol) and is lengthy, up to six months for drug-susceptible, and nine months or more for drug-resistant variants of TB. Although current TB treatment eradicates M.tb from the host body it also causes severe hepatotoxicity and other adverse side effects, causing a large number of patients to withdraw early from therapy. Additionally, displaying a phenomenon called therapy-related immune impairment; TB-treated patients are vulnerable to reactivation or reinfection of the disease. Once patients start feeling better, they often withdraw from treatment, especially those that live in resource-limited environments. Treatment withdrawal is largely responsible for the generation of drug-resistant variants of M.tb, including multidrug-resistant (MDR) and extremely drug-resistant (XDR) forms of M.tb. Therefore, new treatment approaches that reduce treatment regimen lengths and limit hepatotoxicity and other side effects are urgently needed.