How to prevent people living with HIV from dying of TB

Francis Okoye, CNS Correspondent, Nigeria
At a time in the history of the world (1980’s), for anyone to test positive for HIV was a death sentence. Today medical science has developed robust treatment regimens that allow people living with HIV (PLHIV) to live long, as far as they have access to anti retroviral therapy (ART). But of late, this has been jeopardised with the advancement of TB infections in PLHIV. TB and HIV are deeply intertwined, particularly in Sub saharan  Africa. TB has become the leading cause of death among those who are HIV-positive, despite the fact that today HIV infections can be managed with ART and TB can be cured in the vast majority of cases.

Since HIV infection weakens the immune system, PLHIVs are 26 to 31 times more likely to develop active TB than someone who is HIV negative. Of the 1.2 million people who died from HIV in 2014, one in three deaths resulted from TB-HIV co infection. According to a WHO report, 25% of all TB deaths were HIV associated. Also based on post mortem autopsies, nearly half of the PLHIV who died from TB had undiagnosed TB at the time of death. Multi drug-resistant TB (MDR-TB) is another global health crisis and is creating growing challenges to the fight against TB and HIV. According to WHO, an estimated 480,000 people develop MDR-TB annually.     

Treatment for MDR-TB has historically been very difficult and even more difficult for people living with HIV. The first ever recorded outbreak of extensively drug resistant TB (XDR-TB) happened in the Kwazulu Natal province of South Africa-the same province where the TB 2016 and AIDS 2016 conference will be held. The outbreak was reported in the medical literature in 2006. Of the 53 people infected with XDR-TB, 52 died. 44 people with XDR-TB who were tested for HIV were HIV positive.(Source: Since 2006, at least 100 countries have reported cases of XDR-TB. In a webinar for media in lead up to TB 2016 and AIDS 2016, held recently by CNS, Dr Fuad Mirzayev of WHO revealed that South Africa is experiencing TB-HIV co-infection in alarming proportions, recording 450,000 TB cases, 60% of who are PLHIV. UN member states have committed to end TB and AIDS by 2030 by adopting sustainable development goals (SDGS). But unless we ensure that PLHIV do not die of TB, we will not only fail to meet the SDGs but also lose gains made in fighting TB and HIV globally.

What can be done?

*Joint Approach: The WHO first endorsed a policy approach for jointly addressing TB-HIV in 2004. Since 2005, WHO estimates that 5.8 million lives have been saved by interventions that have jointly addressed TB and HIV, Yet in 2014 only half of TB patients worldwide had a documented HIV test result-the first step in initiating treatment and care for TB-HIV co-infection.

*Advocacy and Collaboration: Experts says that it is only through better advocacy and collaboration across the TB and HIV communities that we can find effective,accessible, and sustainable solutions that address TB-HIV and save lives, because very often the communities affected by TB and HIV are the same.

*Government Role: In an answer to a question during the webinar, the experts said that while governments are playing a bigger role in fight against TB and HIV, more needs to be done. It is imperative for developing countries to take a leading role in the fight against TB/HIV.

*Stigma and Discrimination: Some countries have discriminatory and unethical laws that fuel HIV stigma, even while the need of the hour is to wipe out stigma. One of the experts at the webinar, Nomampondo Barnabas, from the International Union Against Tuberculosis and Lung Disease (The Union) shared her experiences of discrimination against TB and HIV, having lived with both the diseases. She said she had to take 5 drugs for TB, 5 for HIV, and 5 other antibiotics daily to survive. But but now things have improved and PLHIV with or without TB have to take fewer drugs. However, she said that many people living with these co-infections never get treated. We need to give the disease a human face and minimize stigma and discrimination. TB and HIV education at school level needs to become more participatory and not imposed.
*Shorter drug regimen for MDR-TB: The adoption of shorter regimens for treating MDR-TB would ensure more treatment adherence so that less people living with HIV and TB die. The short (9-12 months) Bangladesh regimen has recorded a high treatment success rate of 84% and also costs much less than the current 24 month regimen. WHO has given clear recommendations on use of shorter regimens for MDR-TB. also revealed some changes in 2016.

*TB in children living with HIV: Non availability of services are a challenge. Also difficult in diagnosis and under nourishment of the children are other problems faced.

*Example of India: Dr. K.S Sachdeva, an expert from India, gave examples of TB/HIV collaboration in India showing that 85% know they are HIV positive, while 95% of HIV/TB patients are receiving ART. The webinar was moderated by Ashok Ramswarup, former SABC radio producer and Shobha Shukla, of CNS.

Francis Okoye, Citizen News Service - CNS
July 25, 2016