In countries like South Africa where TB is a major cause of death among HIV patients and where an MDR-TB epidemic is emerging, HIV and TB treatment should be combined, researchers say.
"HIV programs have no option but to address TB vigorously to save patient lives, safeguard the massive investment in HIV treatment, and to curb the global TB burden," said Dr Diane V. Havlir, chief of the University of California San Fransisco's HIV/AIDS Division at San Francisco General Hospital's Positive Health Programme and lead author of the paper.
The paper, published in the July 23rd issue of the Journal of the American Medical Association, proposes several strategic activities aimed at fighting the dual burden of HIV and TB. These initiatives could be implemented within existing HIV care and treatment programmes with support by earmarked resources for HIV/TB in the US funded President's Emergency Plan for AIDS Relief and the Global Fund to fight HIV, TB and Malaria.
One recommended measure is intensified TB case finding. The most effective TB control measure is finding and promptly treating TB, according to the authors.
Patients with HIV who are undergoing care should be screened for TB along with members of their household, and the HIV patients who have active TB should be treated for this disease within the HIV programme.
The authors note that because TB may be the disease that brings an HIV patient into care and there are many more clinics for TB than HIV, HIV patients with active TB often are treated in TB clinics and later referred to an HIV programme.
In addition, the authors recommend treating all non TB-infected HIV patients preventively with isoniazid therapy.
Another strategy is the provision of antiretroviral therapy to HIV patients earlier, before their immune systems are severely compromised. This measure would also lessen HIV patients' risk of TB infection, they say.
The authors emphasise that TB infection control measures should be implemented in both outpatient and inpatient HIV care facilities so that TB is not transmitted in these settings. TB should be recorded and reported to national TB programmes by HIV programmes to ensure effective tracking of the TB epidemic, and there should be joint HIV and TB planning, they add. – (EurekAlert)
July , 2008