Low resource countries are at higher risk of TB-HIV deaths

Pretty Chavango, CNS Correspondent, Zimbabwe
Photo Credit: CNS: citizen-news.org
It is expected that in high HIV-TB burden countries— like Zimbabwe, Malawi, and Swaziland— an earlier start of anti retroviral therapy (ART) for people living with HIV (PLHIV) will lead to a reduction in the burden of TB, both new cases and previously treated cases. Despite the fact that TB and HIV/AIDS are now major killers in Zimbabwe and other countries of sub saharan Africa, many people on the continent are unaware of their TB or HIV/AIDS status until they fall sick, further complicating an already deadly situation.

Even though Zimbabwe has achieved tremendous progress in reducing the prevalence and burden of TB, there are still some major challenges in reaching all TB vulnerable populations, especially in mining settlements and prisons, according to WHO Country Representative, Dr David Okello.

HIV and TB can be a lethal combination, each speeding the other’s progress, and people with HIV can die from TB infection within months. TB is able to spread through the body more easily in people living with HIV, which is why TB-HIV coinfection is often associated with extra-pulmonary TB. Active TB accelerates the progress of HIV infection to AIDS in the body.

"The 100-year old TB is now married to the young HIV and the honeymoon is causing a lot of death and misery," said Joshua Chigodora, resource centre programme officer at Southern Africa Aids Information Dissemination Service (SAFAIDS), while presenting a paper titled ‘Tuberculosis and HIV -- a deadly 'marriage' on the dual epidemic of TB and HIV.

The CD4 T-cell count serves as the major laboratory indicator of immune function in PLHIV. It is one of the key factors in determining both-- the urgency of ART initiation and the need for prophylaxis for opportunistic infections. It is also the strongest predictor of subsequent disease progression and survival according to findings from clinical trials and cohort studies. New HIV treatment guidelines by WHO recommend offering ART earlier on. Recent evidence indicates that early ART, irrespective of CD4 T –cell count, will help people with HIV to not only live healthier and longer lives, but also substantially reduce the risk of transmitting HIV to others. The move could avert an additional 3 million deaths and prevent 3.5 million more new HIV infections between now and 2025.

Based on the evidence generated by results of several studies, experts strongly recommend that HIV treatment be started once the CD4 count falls to 500 or lower. Low resource countries are at higher risk of defaulting on treatment. According to DR N. Kumarasamy, Chief Medical Officer at YRGCARE Medical centre, India voluntary HIV screening of the general population even once every 5 years can offer substantial clinical benefit and is cost effective. “Annual screening is cost effective among high risk populations and in high HIV prevalence regions,” he said.

Zimbabweans living with HIV who cannot afford costs of the CD4 cell count that determines the type of medication they must receive are having a nightmarish experience as they are spending entire nights queuing to get tested. While some centres offer free testing for CD4 cell count, others charge between USD1 and  USD5, which is expensive.

Tendai Mhaka, the training and programme manager of the Zimbabwe National Network of People Living with HIV, said more centres which offer free CD4 count service should be established throughout the country.

“It shows there is an acute shortage of CD4 counting machines. It further proves the need to establish more facilities like New Start Centres which offer all requirements for PLHIV--from counselling to providing ART and CD4 cell count-- all under one roof,” she said.

Tobacco consumption also needs to be addressed as a modifiable risk factor common to both diseases. Tobacco control would improve TB and HIV outcomes and care. Dr Angela Jackson-Morris, from the Department of Tobacco Control at the International Union AgainstTuberculsois and Lung Disease (The Union) notes that “Tobaco use exacerbates TB, HIV and TB-HIVSmoking is more prevalent among people with TB and/or HIV. It is associated with TB infection, TB disease, and poorer outcomes for TB treatment. PLHIV are at greater risk from tobacco-related diseases and smoking may also inhibit the effectiveness of life-saving antiretroviral therapies. By incorporating a set of tobacco control practical measures into everyday practice we can improve the treatment outcomes of men, women and children with TB and HIV.”

Pretty Chavango, Citizen News Service - CNS
September 16, 2015

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