Re: FAQs on TB-HIV co infection

[Guest guest]

Dear Sandeep,

The following questions are for both providers and patients.

a. Does HIV increase the risk of TB disease? if so by what fold?

b. Does HIV accelerate TB disease?

c. Does TB accelerate HIV disease?

d. How is the treatment of TB in a co-infected patient different from a non

co-infected patient?

e. If HAART is available should you start it at the same time as TB treatment?

What is the risk of immune reconstitution syndrome?

g. What are the HAART drugs which should not be used along with the TB therapy?

h. What are the most frequent drug-interactions?

i. When using a rifampin containing TB regimen, which HAART drugs are safe to

use?

j. Should all HIV positive patients with positive PPD or Mantoux receive INH

therapy?

k. What is the rate of MDR TB in India? How do you manage MDR TB in a

co-infected patient?

l. Is the HIV/ TB co-infected patient more infectious than non co-infected.

m. Should drug susceptibility testing be done in all co infected patients?

n. How can the spread of TB in the household be prevented?

These are some questions to begin with. An important source of information is

included below. http://aidsinfo.nih.gov/guidelines/

Here is another document from the WHO on the FAQs.

Frequently asked questions about TB and HIV

How can TB and HIV/AIDS work be better coordinated?

The World Health Organization’s interim policy on collaborative TB/HIV

activities* gives guidance on what should be done to address the dual TB and HIV

epidemic. This includes the identification of collaborative TB/HIV activities

and the establishment of TB/HIV coordinating bodies to promote and coordinate

the response of the two programmes at all levels.

Avoid missed opportunities

HIV-positive people can easily be screened for TB; if they are infected they can

be given prophylactic treatment to prevent development of the disease or

curative drugs if they already have the disease. TB patients can be offered an

HIV test; indeed, research shows that TB patients are more likely to accept HIV

testing than the general population. This means TB programmes can make a major

contribution to identifying eligible candidates for ARV treatment.

What is TB?

Tuberculosis is a disease that usually attacks the lungs but can affect almost

any part of the body. A person infected with TB does not necessarily feel ill –

and such cases are known as silent or “latent” infections. When the lung disease

becomes “active”, the symptoms include cough that last for more than two or

three weeks, weight loss, loss of appetite, fever, night sweats and coughing up

blood.

What causes TB?

TB is caused by the bacterium Mycobacterium tuberculosis. The bacterium can

cause disease in any part of the body, but it normally enters the body though

the lungs and resides there.

How is TB spread?

TB is spread from an infectious person to a vulnerable person through the air.

Like the common cold, TB is spread through aerosolized droplets after infected

people cough, sneeze or even speak. People nearby, if exposed long enough, may

breathe in bacteria in the droplets and become infected. People with TB of the

lungs are most likely to spread bacteria to those with whom they spend time

every day – including family members, friends and colleagues.

When a person breathes in TB bacteria, the bacteria settle in the lungs. If that

person’s immune system is compromised, or becomes compromised, the bacteria

begin to multiply. From the lungs, they can move through the blood to other

parts of the body, such as the kidney, spine and brain. TB in these other parts

of the body is usually not infectious.

Is TB treatable?

Yes. TB can be cured, even in people living with HIV. DOTS is the

internationally recommended strategy for TB control.

DOTS treatment uses a variety of powerful antibiotics in different ways over a

long period to attack bacteria and ensure their eradication. Treatment with

anti-TB drugs has been shown to prolong the life of people living with HIV by at

least two years. It is important that people who have the disease are identified

at the earliest possible stage, so that they can receive treatment, contacts can

be traced for investigation of TB, and measures can be taken to minimize the

risk to others.

However, some strains of bacteria have now acquired resistance to one or more of

the antibiotics commonly used to treat them; these are known as drug-resistant

strains.

So TB is a growing concern for people working in the AIDS field?

Yes. It is estimated that one-third of the 40 million people living with

HIV/AIDS worldwide are co-infected with TB. People with HIV are up to 50 times

more likely to develop TB in a given year than HIV-negative people.

Another aspect of the resurgence of TB is the development of drug-resistant

strains. These strains can be created by inconsistent and inadequate treatment

practices that encourage bacteria to become tougher. The multidrug-resistant

strains are much more difficult and costly to treat and multidrug-resistant TB

(MDR-TB) is often fatal. Mortality rates of MDR-TB are comparable with those for

TB in the days before the development of antibiotics.

What are the links between HIV and TB?

HIV/AIDS and TB are so closely connected that the term “co-epidemic” or “dual

epidemic” is often used to describe their relationship. The intersecting

epidemic is often denoted as TB/HIV or HIV/TB. HIV affects the immune system and

increases the likelihood of people acquiring new TB infection. It also promotes

both the progression of latent TB infection to active disease and relapse of the

disease in previously treated patients. TB is one of the leading causes of death

in HIV-infected people.

How many people are co-infected with TB and HIV?

An estimate one-third of the 40 million people living with HIV/AIDS worldwide

are co-infected with TB. Furthermore, without proper treatment, approximately

90% of those living with HIV die within months of contracting TB. The majority

of people who are co-infected with both diseases live in sub-Saharan Africa.

What is the impact of co-infection with TB and HIV?

Each disease speeds up the progress of the other, and TB considerably shortens

the survival of people with HIV/AIDS. TB kills up to half of all AIDS patients

worldwide. People who are HIV-positive and infected with TB are up to 50 times

more likely to develop active TB in a given year than people who are

HIV-negative.

HIV infection is the most potent risk factor for converting latent TB into

active TB, while TB bacteria accelerate the progress of AIDS infection in the

patient.

Many people infected with HIV in developing countries develop TB as the first

manifestation of AIDS. The two diseases represent a deadly combination, since

they more destructive together than either disease alone.

• TB is harder to diagnose in HIV-positive people.

• TB progresses faster in HIV-infected people.

• TB in HIV-positive people is almost certain to be fatal if undiagnosed or left

untreated.

• TB occurs earlier in the course of HIV infection than many other opportunistic

infections.

How much of a threat is TB?

According to WHO, TB infection is currently spreading at the rate of one person

per second. It kills more young people and adults than any other infectious

disease and is the world's biggest killer of women. In 1993, WHO declared TB to

be " a global health emergency " . Every year 8–10 million people catch the disease

and 2 million die from it. About a third of the world's population, or around 2

billion people, carry the TB bacteria but most never develop the active disease.

Around 10% of people infected with TB actually develop the disease in their

lifetimes, but this proportion is changing as HIV severely weakens the human

immune system and makes people much more vulnerable.

What is the impact of TB/HIV on women?

Worldwide, women bear a disproportionate burden of poverty, ill-health,

malnutrition and disease. TB causes more deaths among women than all causes of

maternal mortality combined, and more than 900 million women are infected with

TB worldwide. This year, 1 million women will die and 2.5 million, mainly

between the ages of 15 and 44, will become sick from the disease.

Once infected with TB, women of reproductive age are more susceptible to

developing TB disease than men of the same age. Women in this age group are also

at greater risk of becoming infected with HIV. As a result, in certain regions,

young women aged 15–24 with TB outnumber young men of the same age with the

disease.

While poverty is the underlying cause of much infection in rural areas, poverty

is also aggravated by the impact of TB. In 1996, a study by the World Bank, WHO

and Harvard University reported TB as a leading cause of “healthy years lost”

among women of reproductive age.

What can be done to combat the spread of TB?

The internationally recommended strategy to control TB, known as DOTS, has five

components:

• political commitment to sustained TB control

• access to quality-assured TB sputum microscopy

• standardized short-course chemotherapy, including direct observation of

treatment

• an uninterrupted supply of drugs

• a standardized recording and reporting system, enabling assessment of outcome

in all patients.

The Global Partnership to Stop TB is a global movement to accelerate social and

political action to stop the spread of tuberculosis around the world. The Stop

TB mission is to increase access, security and support in order to:

• ensure that every TB patient has access to TB treatment and cure, and protect

vulnerable populations from TB

• reduce the social and economic toll that TB exacts from families, communities,

and nations.

The Partnership's approach is a coordinated, multinational, multisectoral global

effort to control TB.

Why is more collaborative action on TB and HIV important?

HIV/AIDS is dramatically fuelling the TB epidemic in sub-Saharan Africa, where

up to 70% of TB patients are co-infected with HIV in some countries. For many

years efforts to tackle TB and HIV have been largely separate, despite the

overlapping epidemiology. Improved collaboration between TB and HIV/AIDS

programmes will lead to more effective control of TB among HIV-infected people

and to significant public health gains.

http://www.who.int/tb/hiv/faq/en/

____________________________

Hope this helps.

Fehmida

Fehmida Visnegarwala, MD

Baylor College of Medicine

One Baylor Plaza,BCM 465EC

Houston, Texas-77030, USA

Phone # 713-798-3942

Fax# 713-798-5134

Pager # 281-952-1575

E-mail: <fehmidav@...>