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TB and HIV/AIDS: The intertwined epidemics
HDN Key Correspondent Team. June 2005. A posting from Af-AIDS ([email protected]).
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Along with many other poorer countries, South Africa is witnessing the disastrous intersection of the HIV/AIDS and tuberculosis (TB) epidemics. The World Health Organization (WHO) estimates that the annual incidence of TB in South Africa is 536 cases per 100,000 and that 61% of patients diagnosed with TB are also infected with HIV/AIDS. TB is the most common HIV/AIDS-associated opportunistic infection and is arguably the leading cause of AIDS-related deaths, making prevention and timely treatment of TB crucial to keeping people living with HIV/AIDS alive.
Ironically, HIV/AIDS infection is easy to diagnose with highly accurate serological tests but cannot be cured, while TB can often be difficult to diagnose but can be cured using freely available and highly effective anti-tuberculosis therapy. However, most TB diagnostic tools were developed decades ago, signifying the pressing need for new, cost effective ways to diagnose TB.
At the international AIDS conference in Bangkok last year, Nelson Mandela?’s called upon the global community to fight TB and AIDS together: ?“The world has made defeating AIDS a priority. This is a blessing, but TB remains ignored. Today we are calling on the world to recognize that we can?’t fight AIDS unless we do much more to fight TB as well.
Yet, despite progress in tackling the dual epidemics, TB remains the number one killer of people living with HIV/AIDS and WHO and UNAIDS warn that in many African countries, national TB programmes are only treating half of HIV/AIDS positive patients with active TB.
During the recent national AIDS conference held in Durban, South Africa, Dr Harry Hausler of the University of Western Cape said that of the 8.8 million people in the country estimated by WHO to have TB, 50% is also infected with HIV/AIDS. Yet even though multidrug TB therapy may lead to more side-effects, which in turn could result in the discontinuation of treatment, the impact of TB programmes nevertheless continues to improve.
Furthermore, in places where antiretroviral (ARV) treatment is available, there is a lower incidence of TB among HIV/AIDS-positive people due to improved immunity. Even so, in most of South Africa, along with the majority of African countries, access to ARV treatment is still years away for millions of people. For those unable to access ARVs for the next few years, access to TB prevention and treatment programmes is vital to keeping people alive while they are waiting for life-saving ARV treatment.
Because TB is the most prevalent co-infection among people living with HIV/AIDS, Dr Hausler argued that TB infection could be used as a criterion for initiating ARV treatment. He warned that even when a person with HIV/AIDS is taking ARVs, the potential for developing TB remains high, and if this happens, the individual?’s treatment must be re-examined.
Clinically speaking, dual infection requires expert care and decision-making, especially when patients are taking both HIV/AIDS and TB medications concurrently. And dual treatment also means a large daily pill burden for the patient, which along with various side-effects and possible drug interactions can be challenging for the patient to manage. Therefore, educating patients about treatment and its related side-effects is imperative. Singling out the causative drug or interaction becomes a complex issue with two concurrent multi-drug regimes. In addition, malabsorption of TB drugs has been indicated among many people living with HIV/AIDS and taking ARVs.
In the case of children, TB diagnosis is always more challenging than in adults, and may be made even more complex among children with dual TB and HIV/AIDS infections as a result of other common HIV/AIDS-related conditions and treatments.
For more information about the 2nd annual South African AIDS Conference, go to: www.sa-aidsconference.com
For more information about the Stop-TB partnership, go to: http://www.stoptb.org/
For more information about the Global Drug Facility (aimed to expand access to high-quality TB drugs) go to: http://www.stoptb.org/gdf/. |
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