We need people – people like those in TB Alert, who are focused and ambitious and care for people at grass roots in the UK, India and Africa. Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership
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HIV progressively destroys the immune system making opportunistic infections, such as TB, more likely. People living with HIV are up to 37 times more likely to develop TB than HIV negative people. The risks are even greater in PLHIV who also have a latent TB infection.
HIV makes TB more deadly
People with HIV can die from a TB infection within months. TB is able to spread through the body more easily in PLHIV, which is why TB-HIV is associated with extra-pulmonary TB. Active TB accelerates the replication rate of HIV, speeding the progression towards AIDS.
TB is difficult to diagnose in PLHIV
PLHIV are more likely to have extra-pulmonary or disseminated TB. This cannot be diagnosed through microscopy, the most available method of diagnosis worldwide. Tests that rely on an immune response are also of limited effectiveness, as the immune response is diminished in PLHIV.
TB is more difficult to treat in PLHIV
TB medication and antiretroviral therapy (ART) need to be carefully monitored to avoid adverse drug interactions and side effects in patients. Treatment may take longer in PLHIV, due to the likelihood of extra-pulmonary TB. Even after treatment, PLHIV are more vulnerable to TB. PLHIV that are being treated for pulmonary TB remain infectious to others for longer after initiating treatment.
But deaths are not inevitable
It is important to recognise that TB is curable and HIV can be treated. Early diagnosis of both TB and HIV, leading to treatment or prevention, reduces deaths from co-infection.
In PLHIV, WHO recommends implementation of the Three I’s:
- Intensified case-finding and treatment for TB – after TB treatment is complete, HIV replication returns to the pre-TB rate
- TB prevention through Isoniazid preventative therapy and early antiretroviral therapy
- Control of TB infection in healthcare facilities and other settings
- HIV testing and counselling to identify people with HIV co-infection
- Cotrimoxazole preventive therapy, and antiretroviral therapy for people diagnosed with both TB and HIV
- TB treatment and HIV prevention interventions for people diagnosed with TB only
Find out more: WHO Policy on Collaborative TB/HIV Activities: guidelines for national programmes and other stakeholders
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