Chronic inflammation of tuberculosis

Managing Tuberculosis (TB) infection remains a challenge and there is a need for modern science to infuse new principles. Better use of existing medications, at the stage without effective vaccines and newly developed medications, is a field in urgent need of research effort. This classical infectious disease, in year 2011 alone, actively infected 8.7 million people and 1.4 million people died. TB and human immunodeficiency virus (HIV) HIV co-infection, multidrug-resistant (MDR) as well as extensively drug-resistant (XDR) TB, and clinically significant adverse drug reactions resulting from long-term medication treatment, altogether contributes to complex treatment problems and TB control challenges worldwide. Pharmacogenetics, together with pharmacoepidemiology studies, would help establish better clinical strategies for evaluating, treating, and monitoring tuberculosis patients. Factors affecting the treatment outcome of TB would be an important domain for clinical research. These include reducing patient default from anti-TB treatment, enhancing the adherence of medication administration, improving the cure rate, avoiding TB relapse, and preventing activation of TB infection. Research efforts thus are warranted to investigate the potential risk factors for TB infection from many aspects: comorbidities, social-economic status, health-related behaviors, occupations, use of certain immunosuppressing medications and genetic involvement. For example, monitoring some genetic variations at some loci of the essential liver enzymes, for instance: monitoring the N-acetlytransferase 2 (NAT2), Cytochrome P450 oxidase (CYP2E1), glutathione S-transferases family (GSTs) that metabolizes and detoxifies anti- TB drugs would give good information about these drug responses and their toxicity. Further, this would help to design personalized medicine for TB in the future.