Tackling the burden of TB-HIV co-infection

Lwin Lwin Thant, CNS Correspondent, Myanmar
Photo credit: CNS
The deadly combination of infections by Mycobacterium TB and the Human Immunodeficiency Virus (HIV) appear as a dual epidemic concern in Myanmar. HIV/AIDS cases are reported from large urban areas. Key populations at high risk of HIV are female sex workers and their clients, men who have sex with men and people who inject drugs. Unprotected sex with female sex workers, among men who have sex with men, and among injecting drug users, is also reported to be highly risk as far as contracting HIV is concerned. In Myanmar, HIV related deaths reached their highest point at 19,000 in 2005, but have since decreased as access to anti-retroviral therapies (ART) in the public and NGO sectors of Myanmar increased after 2005. 

A recent study published in the International Journal of Tuberculosis and Lung Disease calls for urgent action to integrate anti-smoking strategies into TB, HIV and TB-HIV care. The study results showed that a decrease in tobacco use, which is a common risk factor for both these diseases, would improve TB and HIV outcomes and care. 

“We are failing people with TB and HIV if we treat smoking as a ‘to do later’ issue. Practitioners and policymakers urgently need to address smoking as part of their care for people with TB and HIV”, said Dr Angela Jackson-Morris from the Department of Tobacco Control, International Union Against Tuberculosis and Lung Disease, and lead author of the study. “Smoking is more prevalent among people with TB or HIV.  It is associated with TB infection, TB disease, and poorer outcomes for TB treatment.  People living with HIV (PLHIV) are at greater risk from tobacco-related diseases and smoking may also inhibit the effectiveness of life saving antiretroviral therapies (ART). By incorporating a set of practical measures into everyday practice we can improve the treatment outcomes of men, women and children with TB and HIV” she added. 

In Myanmar, approximately 7% of adult TB patients are co-infected with HIV. TB is the most opportunistic infection in PLHIV and active TB is detected in 70% of HIV patients. TB and HIV programmes have been established actively in some big cities but they also need to cover the rural countryside. Voluntary confidential counselling and testing, for people with TB, are provided only in very few areas. When I visited Insein Prison hospital in 2014, I found that one detained HIV patient was reluctant to be initiated on ART, even though his CD4 count was below 350, because he was afraid of the side effects of the drugs. This is just one of the many examples that prove it is necessary to provide effective and complete counselling to every PLHIV, regardless of his or her status. The more we provide correct health education about TB and HIV disease in the private and public sector, including prisons and labor camps, the quicker we can achieve better treatment outcomes for TB-HIV in Myanmar.  

“When the patients diagnosed with TB are treated, tested for HIV and switched on to ART, regardless of their CD4 cell count, it benefits them a lot”, said a peer group volunteer from ART clinic of National AIDS Programme. 

Dr N Kumarasamy, CMO, YRGCARE Medical Centre, and Principal Investigator (Chennai) for START trial, was on the panel of experts in a webinar hosted by Citizen News Service. Speaking on the ‘Impact of ART on TB disease in resource limited settings’, he highlighted that “The HPTN 052 study showed that early ART was cost saving over a 5 years period in South Africa. In both South Africa and India, early ART was projected to be very cost-effective over a lifetime. With individual, public health, and economic benefits, there is a compelling case for early ART for sero discordant couples in resource-limited settings”.

With improved ARV drugs having fewer side effects in the market, benefits for PLHIV, who are immediately started on ART regardless of CD4 cells count, will increase more and more.

In Myanmar, ART is provided by the National AIDS Programme (NAP), and by international and local NGOs. More and more PLHIV in need have now started to receive treatment. The requirement for ART will increase, as PLHIV will live longer. When the ART guidelines are revised to follow the World Health Organization’s recommendation to start ART at CD4 count of 500 cells/mm3, then ART needs will increase more. So governments will have to ensure an uninterrupted and smooth supply of anti retroviral drugs to reach the people who need them. Also, Behaviour Changed Communication (BCC) trainings need to be held effectively and efficiently among the high risk populations.   

Lwin Lwin Thant, Citizen News Service - CNS
September 16, 2015

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