Richard Chaisson Richard Chaisson CREATE Principal Investigator Director, Johns Hopkins University Center for Tuberculosis Research rchaiss@jhmi.edu

As described in the July 7, 2011 New England Journal of Medicine, Richard Chaisson from Johns Hopkins University's Center for Tuberculosis Research tested 4 TB prophylaxis regimens in more than 1000 HIV positive people in South Africa who were not on ART. "This new, simpler treatment regimen with rifapentine and isoniazid is highly effective and could transform therapy for latent tuberculosis in both those co-infected with HIV and those not," says study senior author Richard Chaisson, MD, a professor of infectious diseases at the Johns Hopkins University School of Medicine and founding director of its Center for Tuberculosis Research. "New treatment options are urgently needed to help control TB globally, and simpler regimens will substantially increase the number of people receiving therapy," says Chaisson, who points out that fewer than 1 percent of those infected and most likely to develop full-blown TB are receiving drug treatment because of inconvenience, drug side effects and difficulty finding health clinics close to where they live. Chaisson says the latest study in 1,148 South African men and women co-infected with HIV, and another recent study, in which he was also involved, in more than 8,000 men and women in the United States, Canada, Spain and Brazil who mostly were HIV free, show success for the first new treatment option since rifapentine, marketed as the drug Priftin, was approved for use in the United States in 1998. He adds that the results represent the most significant advance in preventing the disease since isoniazid was first proven effective in treating the disease in the 1950s. TB is the leading cause of death among people co-infected with HIV, the virus that causes AIDS, leading to some half-million deaths annually among those co-infected. Chaisson says the streamlined, weekly regimen is much easier for patients to follow, with 95 percent having completed treatment in this study, while traditional daily and longer isoniazid therapy shows a compliance rate of about 60 percent or less in other studies and in practice. This is important, he notes, because isoniazid does not work if treatment is interrupted and people stop taking it as prescribed. Such obstacles in treatment, as well as fears about producing drug-resistant bacteria, in addition to drug toxicity and liver damage in people who also have HIV, probably explain why the vast majority of physicians in South Africa do not prescribe isoniazid treatment alone to prevent TB, Chaisson says, even though it is therapy recommended by the World Health Organization. Observed side effects were mild, Chaisson says, with some liver damage occurring in 20 percent of study participants taking isoniazid for the longer term, and in about 5 percent of those using alternative regimens. However, the key problem with both rifamycin-based medications, Chaisson acknowledges, is that they break down in the liver other drugs, such as protease inhibitors, widely used to fight HIV. Chaisson and his international colleagues next plan to gauge the effectiveness of even shorter regimens, such as high doses of rifapentine and isoniazid daily, but only for one month. He says the aim of his research is to "open up" access to drug therapies for everyone with TB, as a means of better controlling the disease.

Richard E. Chaisson, MD, Director, Center for Tuberculosis Research, Johns Hopkins Univ.

Richard E. Chaisson, M.D. - CREATE Principal Investigator Richard Chaisson Director of the Johns Hopkins Center for Tuberculosis Research Richard E. Chaisson, M.D., is Professor of Medicine, Epidemiology and International Health at the Johns Hopkins University in Baltimore. He received his BS and MD degrees from the University of Massachusetts, and was an intern, resident and fellow at the University of California, San Francisco, where he was also Assistant Professor of Medicine. From 1988-1998 he was director of the Johns Hopkins AIDS Service, and he co-founded the Johns Hopkins HIV Clinic cohort, an observational study that has been the source of more than 130 scientific publications on the outcomes of HIV disease and its treatment. Dr. Chaisson is currently Director of the Johns Hopkins Center for Tuberculosis Research, a multidisciplinary center with more than $60 million in grants for the study of TB from bench to bedside. Dr. Chaisson's research interests focus on tuberculosis and HIV infection, including global epidemiology, clinical trials, diagnostics and public health interventions. He is currently principal investigator of 11 research grants, and is director of the Consortium to Respond Effectively to the AIDS/TB Epidemic (CREATE), an international research consortium funded by the Bill and Melinda Gates Foundation to assess the impact of novel strategies for controlling HIV-related TB. He has published over 300 scientific papers and book chapters. To see a list of the most recent articles and abstracts from Dr. Richard Chaisson and colleagues, click here. Click here to see a list of Dr. Chaisson's major papers and to read a profile that appeared in the January, 2005, issue of Nature Medicine.

Richard E. Chaisson, MD rchaiss@jhmi.edu Co-Principal Investigator