HIV/AIDS - Multidrug-resistant Tuberculosis without extensive drug resistance

• 2012Bedaquiline approved (FDA)
• 2014Delamanid approved (FDA)
• 2019Pretomanid approved (FDA)

Trials started per year, stacked by phase (darker = later phase). Source: ClinicalTrials.gov via Clin2, which tracks studies recruiting in recent years — early years undercount.

Most people with multidrug-resistant TB without extensive drug resistance can now be cured or prevented. The turning point was the FDA’s 2012 approval of bedaquiline, followed by delamanid in 2014 and pretomanid in 2019. Death rates have been falling steadily as these all-oral regimens reach more clinics. The pipeline is also active: 20 trials started in the last five years, 22 are currently running, and seven are in late-stage trials. The major remaining challenge is not drug discovery but delivery. These medicines must reach the clinics, the labs, and the patients who need them before capability becomes real access.

Can someone living with HIV be cured of multidrug-resistant TB?

Yes. Bedaquiline- or pretomanid-based regimens cure most people with multidrug-resistant TB, including people living with HIV. Outcomes are strongest when TB care and HIV care are delivered together. Such services are not equally available everywhere, so access still governs the result.

Where does the global fight against MDR-TB actually stand?

Death rates from drug-resistant TB have been falling slowly for years as detection and treatment improve. The direction is genuinely improving, but progress is uneven. Many places still lack rapid drug-susceptibility testing and affordable access to newer drugs.

Why did the 2012, 2014, and 2019 approvals matter so much?

They were turning points. Bedaquiline brought the first new mechanism in decades, delamanid offered another option in 2014, and pretomanid strengthened all-oral treatment in 2019. Together, these drugs made multidrug-resistant TB curable for most instead of a longer, injectable-only disease.

What are the current trials trying to improve?

The immediate goal is shorter, simpler, and safer MDR-TB cures. Twenty-two trials are actively running, seven in phase 3, and 20 have begun in the last five years. Success would make effective treatment faster to tolerate and easier to provide.

If a cure is possible, why don’t all patients recovered?

A cure is a medical possibility, not the same as universal care. Patients need quick, accurate drug-susceptibility tests; a continuing new medication supply; and trained teams to support the entire course. Without the people and supplies, the evidence of cure cannot translate into results everywhere.