{"id":27503,"date":"2017-03-10T11:27:49","date_gmt":"2017-03-10T10:27:49","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=27503"},"modified":"2017-03-10T11:27:49","modified_gmt":"2017-03-10T10:27:49","slug":"tuberkuloza-zabije-vice-lidi-nez-aids-a-naucila-se-odolat-antibiotikum-pomuze-revolucni-lek","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=27503","title":{"rendered":"Tuberkul\u00f3za zabije v\u00edce lid\u00ed ne\u017e AIDS a nau\u010dila se odolat antibiotik\u016fm. Pom\u016f\u017ee revolu\u010dn\u00ed l\u00e9k?"},"content":{"rendered":"

Ro\u010dn\u011b se objev\u00ed a\u017e p\u016fl milionu nov\u00fdch p\u0159\u00edpad\u016f tuberkul\u00f3zy \u2013 a spolehliv\u00fdch l\u00e9k\u016f naopak ub\u00fdv\u00e1. V\u011bdci jsou ale na stop\u011b nov\u00e9ho l\u00e9\u010diva.<\/strong><\/p>\n

L\u00e9ka\u0159i bez hranic ve spolupr\u00e1ci s dal\u0161\u00edmi zdravotnick\u00fdmi organizacemi zah\u00e1jili v\u00fdznamn\u00e9 klinick\u00e9 testy, jejich\u017e c\u00edlem je p\u0159in\u00e9st zcela nov\u00fd zp\u016fsob l\u00e9\u010dby nejt\u011b\u017e\u0161\u00edch forem tuberkul\u00f3zy (TBC). Ty pat\u0159\u00ed mezi nejv\u011bt\u0161\u00ed infek\u010dn\u00ed zabij\u00e1ky na sv\u011bt\u011b. Prvn\u00ed pacient zapo\u010dal novou l\u00e9\u010dbu minul\u00fd t\u00fdden v Gruzii.<\/p>\n

Klinick\u00e9 testy jsou sou\u010d\u00e1st\u00ed takzvan\u00e9ho projektu endTB, jeho\u017e c\u00edlem je urychlit a roz\u0161\u00ed\u0159it p\u0159\u00edstup k lep\u0161\u00ed a krat\u0161\u00ed l\u00e9\u010db\u011b rezistentn\u00edch forem tuberkul\u00f3zy.<\/p>\n

Tuberkul\u00f3za se u\u010d\u00ed odol\u00e1vat antibiotik\u016fm<\/p>\n

Tuberkul\u00f3za byla des\u00edtky let opom\u00edjena, postupn\u011b se z n\u00ed stala jedna z nejsmrteln\u011bj\u0161\u00edch infek\u010dn\u00edch nemoc\u00ed, a\u017e v tomto ohledu p\u0159ed\u010dila i HIV\/AIDS. P\u0159edminul\u00fd rok na ni zem\u0159elo 1,8 milion\u016f lid\u00ed. Zvl\u00e1\u0161\u0165 z\u00e1va\u017en\u00fdm probl\u00e9mem jsou komplikovan\u00e9 formy nemoci, kter\u00e9 jsou rezistentn\u00ed v\u016f\u010di l\u00e9k\u016fm pou\u017e\u00edvan\u00fdm na tuberkul\u00f3zu, a b\u011b\u017en\u00e1 l\u00e9\u010dba na n\u011b nezab\u00edr\u00e1. Mezi tyto formy tuberkul\u00f3zy pat\u0159\u00ed multirezistent\u00ed tuberkul\u00f3za (MDR-TBC), je\u017e je odoln\u00e1 v\u016f\u010di antibiotik\u016fm prvn\u00ed linie, anebo z\u00e1va\u017en\u011bj\u0161\u00ed extenzivn\u011b rezistentn\u00ed tuberkul\u00f3za (XDR-TBC), na kterou nezab\u00edraj\u00ed ani antibiotika druh\u00e9 linie. Sv\u011bt v boji s t\u011bmito formami TBC pokulh\u00e1v\u00e1. Opatrn\u00e9 odhady Sv\u011btov\u00e9 zdravotnick\u00e9 organizace (WHO) stoupaj\u00ed a nyn\u00ed uv\u00e1d\u011bj\u00ed, \u017ee ro\u010dn\u011b se objev\u00ed p\u016fl milionu nov\u00fdch p\u0159\u00edpad\u016f.<\/p>\n

Tyto formy tuberkul\u00f3zy jsou z\u00e1va\u017en\u00fdm probl\u00e9mem pro ve\u0159ejn\u00e9 zdrav\u00ed v mnoha zem\u00edch. Jsou toti\u017e stejn\u011b naka\u017eliv\u00e9 jako b\u011b\u017en\u00e1 tuberkul\u00f3za, jejich l\u00e9\u010dba je ale zna\u010dn\u011b komplikovan\u011bj\u0161\u00ed. O MDR-TBC a XDR-TBC se n\u011bkdy mluv\u00ed jako o „ebole s k\u0159\u00eddly“, \u00fasp\u011b\u0161nost l\u00e9\u010dby t\u011bchto forem TBC je toti\u017e obdobn\u00e1 \u00fasp\u011b\u0161nosti l\u00e9\u010dby eboly, tuberkul\u00f3za se ale na rozd\u00edl od eboly \u0161\u00ed\u0159\u00ed vzduchem.<\/p>\n

Sou\u010dasn\u00e1 l\u00e9\u010dba multirezistentn\u00ed tuberkul\u00f3zy je dlouh\u00e1 (trv\u00e1 a\u017e 24 m\u011bs\u00edc\u016f), neefektivn\u00ed (\u00fasp\u011b\u0161nost vyl\u00e9\u010den\u00ed se pohybuje kolem 50 procent) a mnohdy m\u00e1 v\u00e1\u017en\u00e9 vedlej\u0161\u00ed \u00fa\u010dinky v\u010detn\u011b akutn\u00edch psych\u00f3z \u010di trval\u00e9 hluchoty. Pacienti nav\u00edc mus\u00ed sn\u00e1\u0161et m\u011bs\u00edce ka\u017edodenn\u00edch bolestiv\u00fdch injekc\u00ed a b\u011bhem l\u00e9\u010dby spolykat a\u017e 14 tis\u00edc pr\u00e1\u0161k\u016f. Proto\u017ee je l\u00e9\u010dba dlouh\u00e1 a cenov\u011b n\u00e1kladn\u00e1, je v mnoha posti\u017een\u00fdch zem\u00edch prakticky nedostupn\u00e1.<\/p>\n

V r\u00e1mci snahy vy\u0159e\u0161it tento probl\u00e9m se ve t\u0159et\u00ed f\u00e1zi klinick\u00fdch test\u016f nyn\u00ed zkou\u0161ej\u00ed prvn\u00ed dva nov\u00e9 l\u00e9ky, kter\u00e9 byly v posledn\u00edch pades\u00e1ti letech vyvinuty \u2013 bedaquiline a delamanid. C\u00edlem je \u0161etrn\u011bj\u0161\u00ed a radik\u00e1ln\u011b krat\u0161\u00ed l\u00e9\u010dba (dev\u00edtim\u011bs\u00ed\u010dn\u00ed) multirezistentn\u00edch forem TBC, kter\u00e1 by se obe\u0161la bez injekc\u00ed. Nov\u00e9 l\u00e9ky budou v r\u00e1mci experiment\u00e1ln\u00ed l\u00e9\u010dby kombinov\u00e1ny s dal\u0161\u00edmi l\u00e9ky proti tuberkul\u00f3ze jako je nap\u0159\u00edklad clofazimine, linezolid, fluoroquinolones a pyrazinamide.<\/p>\n

V sou\u010dasn\u00e9 dob\u011b m\u016f\u017ee l\u00e9\u010dbu multirezistentn\u00ed tuberkul\u00f3zy podstoupit pouze 10 procent nemocn\u00fdch, p\u0159\u00edstup k bedaquilinu a delamanidu maj\u00ed m\u00e9n\u011b ne\u017e 2 procenta naka\u017een\u00fdch. Klinick\u00e9 testy roz\u0161\u00ed\u0159\u00ed poznatky o pou\u017eit\u00ed bedaquilinu a delamanidu \u2013 zejm\u00e9na jejich vyu\u017eit\u00ed coby sou\u010d\u00e1sti jednodu\u0161\u0161\u00edch a lep\u0161\u00edch l\u00e9\u010debn\u00fdch postup\u016f, kter\u00e9 bude snaz\u0161\u00ed zav\u00e1d\u011bt v chud\u0161\u00edch zem\u00edch siln\u011b zat\u00ed\u017een\u00fdch tuberkul\u00f3zou.<\/p>\n

„Pacienti s multirezistentn\u00ed tuberkul\u00f3zou se mnohdy l\u00e9k\u016f ob\u00e1vaj\u00ed stejn\u011b jako nemoci samotn\u00e9. Ztr\u00e1cej\u00ed energii, n\u011bkdy i sv\u016fj sluch a zrak a na dva roky se vzd\u00e1vaj\u00ed b\u011b\u017en\u00e9ho \u017eivota. Mnoho let jsem sledoval projekty L\u00e9ka\u0159\u016f bez hranic zam\u011b\u0159en\u00e9 na l\u00e9\u010dbu tuberkul\u00f3zy po cel\u00e9m sv\u011bt\u011b a jsem p\u0159esv\u011bd\u010den, \u017ee ned\u00e1vn\u00e9 schv\u00e1len\u00ed dvou nov\u00fdch l\u00e9k\u016f \u2013 bedaquilinu a delamanidu, p\u0159edstavuje jedine\u010dnou p\u0159\u00edle\u017eitost pro v\u00fdvoj nov\u00fdch l\u00e9\u010debn\u00fdch postup\u016f, kter\u00e9 by mohly zm\u011bnit \u017eivot pacient\u016fm s multirezistentn\u00edmi formami tuberkul\u00f3zy. Oba l\u00e9ky vykazuj\u00ed velmi slibn\u00e9 v\u00fdsledky, pokud se kombinuj\u00ed s dosavadn\u00ed zdlouhavou a \u0161patn\u011b tolerovanou l\u00e9\u010dbou multirezistentn\u00ed tuberkul\u00f3zy. O jejich optimalizaci ale v\u00edme velmi m\u00e1lo. Bez dal\u0161\u00edho v\u00fdzkumu se pohybujeme pouze po povrchu probl\u00e9mu, zat\u00edmco pacienti trp\u00ed,“ uvedl Francis Varaine, vedouc\u00ed pracovn\u00ed skupiny L\u00e9ka\u0159\u016f bez hranic zam\u011b\u0159en\u00e9 na TBC a jeden z hlavn\u00edch v\u00fdzkumn\u00edk\u016f pod\u00edlej\u00edc\u00edch se na klinick\u00fdch testech v r\u00e1mci endTB.<\/p>\n

S pomoc\u00ed Harvardu<\/p>\n

Klinick\u00e9 testy, kter\u00e9 L\u00e9ka\u0159i bez hranic spolufinancuj\u00ed, t\u011b\u017e\u00ed z expert\u00edzy l\u00e9ka\u0159sk\u00e9 fakulty Harvardovy univerzity, asociace Epicentre a Institutu tropick\u00e9 medic\u00edny v Antverp\u00e1ch. T\u00fdmy, je\u017e prov\u00e1d\u00ed klinick\u00e9 testy, tak\u00e9 v jednotliv\u00fdch zem\u00edch \u00fazce spolupracuj\u00ed s ministerstvy zdravotnictv\u00ed a n\u00e1rodn\u00edmi programy pro l\u00e9\u010dbu tuberkul\u00f3zy, s WHO a etick\u00fdmi komisemi.<\/p>\n

Jedn\u00e1 se o druh\u00fd klinick\u00fd v\u00fdzkum l\u00e9\u010dby tuberkul\u00f3zy, kter\u00fd spolufinancuj\u00ed L\u00e9ka\u0159i bez hranic. P\u0159edchoz\u00ed testy v r\u00e1mci projektu TB Practecal zapo\u010daly v lednu 2017 v Uzbekist\u00e1nu.<\/p>\n

Fakta
\nProjekt endTB<\/p>\n

Projekt endTB (z anglick\u00e9ho v\u00fdrazu „expand new drug markets for TB“) si klade za c\u00edl nal\u00e9zt s pomoc\u00ed nov\u00fdch l\u00e9k\u016f bedaquiline a delamanid krat\u0161\u00ed, m\u00e9n\u011b toxick\u00e9 a efektivn\u011bj\u0161\u00ed postupy pro l\u00e9\u010dbu multirezistentn\u00edch forem TBC. \u010cty\u0159let\u00fd projekt za zhruba 1,5 miliardy korun financuje Mezin\u00e1rodn\u00ed fond pro n\u00e1kup l\u00e9\u010div (UNITAID) a pod\u00edlej\u00ed se na n\u011bm L\u00e9ka\u0159i bez hranic, organizace Partners in Health (PIH) a Interactive Research and Development (IRD). Projekt endTB se zam\u011b\u0159uje na 15 zem\u00ed nap\u0159\u00ed\u010d t\u0159emi kontinenty. Do l\u00e9\u010dby chce za\u0159adit zhruba 2600 pacient\u016f s multirezistentn\u00ed tuberkul\u00f3zou. Do samotn\u00fdch klinick\u00fdch test\u016f se zapoj\u00ed na 750 pacient\u016f nap\u0159\u00ed\u010d \u0161esti zem\u011bmi: Gruzi\u00ed, Kazachst\u00e1nem, Kyrgyzst\u00e1nem, Lesothem, Peru a JAR. V\u0161echny tyto zem\u011b jsou siln\u011b zat\u00ed\u017een\u00e9 tuberkul\u00f3zou a partne\u0159i projektu endTB tam podporuj\u00ed m\u00edstn\u00ed aktivity zam\u011b\u0159en\u00e9 na l\u00e9\u010dbu MDR-TBC.<\/p>\n

\u010ct24<\/p>\n","protected":false},"excerpt":{"rendered":"

Ro\u010dn\u011b se objev\u00ed a\u017e p\u016fl milionu nov\u00fdch p\u0159\u00edpad\u016f tuberkul\u00f3zy \u2013 a spolehliv\u00fdch l\u00e9k\u016f naopak ub\u00fdv\u00e1. V\u011bdci jsou ale na stop\u011b nov\u00e9ho l\u00e9\u010diva.<\/p>\n<\/div>","protected":false},"author":1,"featured_media":14877,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[],"class_list":["post-27503","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zpravy"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/27503","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=27503"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/27503\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/14877"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27503"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27503"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27503"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}