A deadly concoction

Photo credit: CNS: citizen-news.org
Paidamoyo Chipunza, CNS Correspondent
(first published in The Herald, Zimbabwe)
“HIV destroys the immune system. When this happens, the capsule containing the TB germs weakens and breaks. The germs spill out and multiply. The person becomes sick with tuberculosis, transmitting the germs to others through a tell tale cough,” were the words of Nobel Peace Prize Laureate Archbishop Desmond Tutu, himself a TB survivor, sometime in 2012. However, health experts say diabetes has the same effect on the immune system like HIV.

Senior advisor with the International Union Against Tuberculosis and Lung Disease (The Union), Professor Anthony Harries told journalists attending the National Press Foundation three-day J2J training ahead of the world TB conference that just like the HIV-TB combination, diabetes-TB increase TB cases.

Prof Harries also said diabetes, just like HIV, makes it more difficult to diagnose TB, increases deaths for people with TB, chances of recurrent TB and chances of treatments failures.

He said diabetes, otherwise known as “sugar” in layman’s language, compromises the immune system and makes the victim’s lungs susceptible to Tuberculosis (TB), making people with diabetes three times more likely to suffer from tuberculosis.

When the immune system is compromised it becomes susceptible to a number of infections such as HIV and TB. Prof Harries said an estimated two billion people in the world have TB bacteria somewhere in their bodies but are not sick from the disease and might never get sick from the same (latent TB).

He said between five to 15 percent of people with latent TB are at risk of developing active TB should they be exposed to HIV, malnutrition, smoke, alcohol and now, diabetes.

TB infection leads to gradual but severe weight loss, night sweats and the bloody cough. At this stage, the infection can spread to people nearby. People with a weak immune system are more likely to develop active TB.

“Patients with diabetes have impaired immunity and poor lung defences against TB,” said Prof Harries.

He said studies have also shown that oral diabetes medicines can decrease the effectiveness of TB medicines making co-existence of the two quite lethal.

Prof Harries said this lethal combination increases the risk of death, recurrent TB and liver toxicity among other complications.

“We saw something similar happen with TB and HIV and Aids to what is happening now with TB and diabetes.
Dr Anthony Harries, The Union (L),
Dr Anil Kapur, WDF (R)

“For years we had medical evidence that the two diseases were working together as HIV destroyed people’s immune systems, allowing TB to quadruple in many countries in Africa,” he said.

He said it, however, took years to have a policy framework for a robust response to the HIV/TB epidemic resulting in loss of many lives due to the deadly duo. “We want to raise an alarm that we do not watch history repeat itself with TB-diabetes,” he said.

According to a report released by The Union in conjunction with the World Diabetes Foundation recently in Barcelona titled: The looming co-epidemic of TB diabetes: a call to action, people with diabetes are three times more likely to develop tuberculosis than people without the disease.

The report projects a global increase of diabetes cases from current 382 million (2013) to about 592 cases in 2035 with the burden of the disease moving from developed countries into developing countries in Africa.

“Unless steps are taken to halt the trend, the consequence will be an increasing number of people who develop tuberculosis as a result of diabetes, potentially reversing the progress made against TB over the last few decades,” reads part of the report.

Another report on TB released last week by the WHO showed that TB was on a downward trend.

In Zimbabwe, about 35 278 new TB cases were recorded in 2013, down from 38 367 recorded the previous year.

In 2011, the country recorded about 41 000 cases, down from over 47 000 recorded in 2010.

The report further indicates the mortality rate from TB has dropped by 45 percent since 1990, while the number of new cases is declining by an average of 1,5 percent per annum globally.

An estimated 37 million lives have been saved through effective diagnosis and treatment of TB since 2000, according to the WHO. On the contrast, diabetes cases are on the increase with about 600 670 cases recorded in 2013 alone.

The Zimbabwe Diabetes Association estimates that 10 in every 100 people have diabetes in Zimbabwe.

With latest evidence showing that existence of diabetes can triple development of TB and co-existence of both diseases can be lethal- the health community has embarked on a worldwide campaign to tackle the looming epidemic.

A member of the board of directors for World Diabetes Foundation (WDF) Dr Anil Kapur said just like in the HIV-TB response where people with HIV where also screened for TB and vice versa, this same approach should happen to TB and diabetes.

He said countries should start screening diabetes in people with TB and just as well people with TB should be screened for diabetes.

“If you have diabetes and live in a country with a high burden of TB, it is important that you find out if you also have TB. If you have TB, then you get treatment. Now, if you have TB and you don’t know whether you have diabetes, it doesn’t matter where you live — you should find out if you have diabetes,” said Dr Kapur.

Asked whether the international community will assist mobilise resources for an accelerated response to the looming TB-diabetes epidemic considering the fact that most African countries are still burdened by HIV and other emerging public health threats such as Ebola, Mr Kapur said that is the major obstacle, which needs to be looked into.

He said in most African countries treatment for TB and HIV is free but if ever it is available, treatment for diabetes is not free. Mr Kapur said his organisation in partnership with The Union and other organisations were working flat out to explore ways of making diabetes treatment widely available.

“We have been pushing and many other organisations, the IDF, The Union, everybody else has been pushing for global attention to non-communicable diseases but to mobilise resources in a very big way, it is going to be challenging,” he said.

National TB programme manager in the Ministry of Health and Child Care Dr Charles Sandy said for now diabetes was not a major challenge to Zimbabwe in comparison to HIV.

He, however, said with latest evidence from the TB-diabetes report and with resources permitting, Government would look into ways of responding to the potential epidemic.

However, Government is already doing some work on diabetes under the department of non-communicable diseases.

(first published in The Herald, Zimbabwe)

Paidamoyo Chipunza, Citizen News Service - CNS
5 November 2014