Clinical Impact of Anti-TB Drug Levels and M. Tuberculosis Susceptibility

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DESCRIPTION (provided by applicant): Abstract PI: HEYSELL, SCOTT K Project: 1K23AI099019-01 Title: Clinical Impact of Anti-TB Drug Levels and M. Tuberculosis Susceptibility Accession Number: 3398392 ================== NOTICE: THIS ABSTRACT WAS EXTRACTED FROM APPLICATION AND HAS NOT BEEN PROOFED BY AN SRA.WHEN THERE ARE PROBLEMS WITH THE APPLICATION SCANNING PROCESS, THE EXTRACTED TEXT MAY BE INCORRECT OR INCOMPLETE. ================== Worldwide tuberculosis (TB) treatment failure occurs in up to 20% of individuals despite multidrug therapy. In Virginia we have found diabetes to be a significant risk factor for delayed response. At our collaborative site in Tanzania, patients with multidrug-resistant (MDR)-TB are at increased risk of death compared to those with drug-susceptible TB. In both settings we have found low serum drug levels to TB medications, however the best use of serum drug levels in managing TB remains unclear. To inform this problem we have developed a TB drug activity assay that is performed with a patient's plasma or serum while on TB therapy and their autologous TB isolate that allows a metric of both drug levels and relative resistance of the isolate. In this proposal, therefore, we will compare (1) drug levels, (2) M. tuberculosis drug susceptibility (MIC), and (3) the TB drug activity assay to relevant treatment outcomes in patients at risk of poor treatment failure- diabetics in Virginia and those with MDR-TB in Tanzania. The proposal leverages an existing state TB control initiative of early drug level monitoring and dose adjustment in diabetics, and will further establish a cohort of MDR-TB patients at Kibong'oto National TB Hospital, the Tanzanian referral hospital for MDR-TB. Active funding and infrastructure for all aspects of the proposal exist through an NIH R01 for TB susceptibility, an NIH/Fogarty UVA-Tanzania Training Grant, and the Virginia Department of Health. My career development plan includes mentorship, graduate level coursework, and publication benchmarks in diagnostic development, field research, TB pharmacology, and MDR-TB cohort design. Completion of this proposal will allow me to become an independent investigator in these fields. PROJECT NARRATIVE Tuberculosis (TB) treatment failure occurs despite multidrug therapy. Currently there are not practical tools for measurement of drug activity in many TB-endemic/ resource-limited settings. The proposed project will study two populations at-risk of treatment failure: those with diabetes and those with multidrug-resistant TB. Completion of these studies will inform the use of three potential methodologies: drug levels, M. tuberculosis drug MICs, and a novel TB drug activity assay which can be performed in settings capable of TB culture.