Addressing TB Risk Factors May Be Fruitful Approach to Mitigating Disease

In the era of multi-drug resistant strains of tuberculosis (TB), it is important to identify other ways to mitigate and prevent disease. According to the World Health Organization (WHO), an estimated 10.6 million cases of TB occur worldwide annually, and India accounts for 27 percent.

BUSM researchers collaborated with the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) in India and Rutgers University in New Jersey and found a striking link between malnutrition, heavy alcohol use and tuberculosis (TB) in Southern India. The study appears in the August issue of the journal PLOS ONE.

From the data collected on a large cohort of TB cases using Regional Prospective Observational Research for Tuberculosis (RePORT), the authors conducted a sub-analysis to identify drivers of TB risk in the region. The study evaluated those recently diagnosed with TB in Puducherry and Tamil Nadu, India and compared the study data to population level data in the area. The researchers calculated that more than 61 percent of TB cases in women are attributable to malnutrition. The study also found that up to 75 percent of male TB cases could be eliminated if the impact of alcohol was reduced.

This study comes on the heels of the WHO’s strategy that encourages research into country-specific TB research plans. “We hope this demonstration of how malnutrition and alcoholism are driving the TB epidemic in India will help local TB programs target resources to reduce the local burden of TB,” explained corresponding author Natasha Hochberg, MD, MPH, assistant professor of medicine and an infectious disease physician and co-director of the Travel Clinic at Boston Medical Center. She added, “The Indian government has recently released guidelines for the nutritional care of TB patients; we anticipate that our findings will bolster their efforts and renew the emphasis on addressing malnutrition to prevent TB.” The researchers also note a scarcity of alcohol treatment programs in the Puducherry and Tamil Nadu region and that heavy alcohol use has an impact on TB treatment outcomes.

In the developing world, multi-drug resistant strains of tuberculosis are becoming more prevalent. Worldwide it is estimated that four percent of all new TB cases are multidrug resistant with India having some of the highest numbers of cases. This is likely attributable to both inappropriate therapy and compliance issues. The latter brings these new findings into focus as malnutrition and alcohol use may be contributing to more incompletely treated cases and more resistance. Therefore, instead of developing new antibiotic combinations as is the conventional approach it may be helpful to first address these other risk factors for harboring the disease.

Submitted by Robert Martin, MD.