Tuberculosis and HIV: The unholy marriage
Guardian - Dar es Salaam,United Republic of Tanzania, By MATILDA KASANGA, February 12, 2006
In recent years, the number of people with active Tuberculosis has increased where there is a large population of people infected with HIV. Experts say TB and HIV are like twins more especially when the duo affect one person. MATILDA KASANGA explains the symbiotic relationship between the two diseases and methods of treatment.
`I have been living with HIV for the past 10 years but I am now on ARVs and my CD 4 is 432.
It was a great challenge when I got to know that I had TB of the chest, knee and lymph nodes in the year 2000. Time seemed no longer to be on my side then. Coupled with weight loss, loss of appetite and night sweats, it was my worst time when they were not able to diagnose my TB.
My doctor then decided that I start my ARVs with my TB treatment - my CD4 count was 30 at this point in time. This led to a paradoxical reaction that complicated my recovery and I ended up staying in hospital for a period of seven months` says Lucy Chesire a TB/HIV advocate from Kenya.
Chesire continues: `During the same time, I was able to undergo three operations : one on the neck and two on my left leg. When I got out of hospital, I weighed about 48 kilos and I had to use crutches for a period of three months. It wasn’t easy.`
`I was able to recover and today my experience with TB has given me an opportunity to make my voice audible and advocate for TB and more so for the combination of TB and HIV programmes so that at the end of the day, since we are dealing with two diseases in one patient, we can be able to decrease the burden and give the person living with HIV a chance to get better treatment.`
The case of Selina illustrates that although she is infected with HIV, her TB has been cured.
Selina , a 30 year old mother of four who lives in Makambako, is a living example of proof that TB treatment is remarkably effective in people living with HIV.
‘I was married at the age of 16, but left my husband after giving birth to my second child because of his alcohol problem. I was afraid of him so I came to stay with my mum. Life was so hard and I had no other way to earn a living other than selling sex. ` When her baby was only four months old, Selina started to become sick with a cough , headache fever and chest pains,
She was taken to the hospital where she was diagnosed with TB. She returned home and was treated as part of the home-care services conducted by health workers and many volunteers offering support to People Living with HIV/AIDS. The health workers from the home- based team counselled her on the need to go for HIV testing.
She was found HIV positive but she says she was not entirely shocked as she knew her background quite well. People told her that there was no point in her having TB treatment because she would die of AIDS anyway, But Selina did complete her treatment and made a full recovery like Ms Chesire.
She even put on weight, and it is more than four years since she was diagnosed HIV positive and she is still leading a full and economically productive life. Chesire and Selina’s cases are just the tip of the iceberg. There are millions of women, men and children dying of TB worldwide, while the disease is preventable and curable.
There are nearly 42 million men, women and children living with HIV in the world today, more that 95 percent of whom are in the developing world where the highest rates of TB infection are found. More than 11 million are dual infected with TB and HIV.
It is an indisputable fact that the number of people with active TB has been observed to increase where there is a large number population of people infected with HIV. According to Dr Sitienei, the Kenyan TB-HIV National Coordinator, this increase in the numbers of TB cases can mainly be attributed to the HIV epidemic.
It is thought that HIV promotes the development of active TB in those with both previously and recently acquired tuberculosis infection. According to Dr. Sitienei, HIV destroys the cells that protect the body from getting infected with the TB bacillus which consequently attacks the body without hindrance. TB cases reported in Kenya have doubled over the years.
A study conducted on TB patients in 1994 showed that 40-60 percent of TB patients also had HIV. In some areas, the HIV sero prevalence in TB patients is as high as 92 percent. He says HIV also increases the risk of recurrent TB in those who have received recommended TB treatment regimes and been cured. This in turn increases the risk of TB transmission to the general community, Dr Sitenei says.
Although Kenya is facing a high TB burden, which is fuelled by the concurrent HIV epidemic, the majority of TB patients are not offered HIV diagnostic and testing and counselling and are therefore not aware of their HIV status. Similarly, many people living with HIV/AIDS have no access to an essential package of care and screening for TB and TB preventive therapy where appropriate.
He says an HIV positive person has a 50 percent chance of developing TB in his lifetime.
Impact of HIV on TB
The impact of HIV on TB is huge. It increases TB burden, morbidity and mortality. Dual stigma for both TB and HIV is common. Many suspected TB patients are reluctant to present themselves for screening because they fear that they will be labeled as having HIV/AIDS if found with TB.
Of further importance, says Dr Sitinei, the growing numbers of TB cases are due to the worsening socio-economic conditions, increasing urbanization with deteriorating urban infrastructure. HIV is the most significant cause of the dramatic rise in TB from the mid 1980s onwards.
Today TB is the single biggest killer of people infected with HIV. `The presence of TB greatly reduced the quality of life and ability to live, among people who are HIV positive. If their TB is not effectively treated, they have a high likelihood of dying within a few months,` says Dr Sitinei.
In Kenya, it is estimated that over the last ten years, there has been a ten-fold increase of TB cases which may be attributed to HIV/AIDS. In Kenya, since last year, the country has introduced a policy whereby every person who comes for TB diagnosis is also advised to undergo an HIV test in order to facilitate easy treatment in case he tests positive.
If I have TB does it mean that I have HIV/AIDS? Over the last ten years, many people have been asking this question simply because they suspect that once one has TB, one is automatically infected with HIV.
`If you have TB it doesn’t mean you have HIV/AIDS, ` says Dr. Vicent Ombeka, the Nairobi Provincial Tuberculosis’s and Leprosy Coordinator. He says it is not always that a person with HIV/ AIDS has TB.
Dr. Ombeka says there is a need for HIV/AIDS and TB programmes to work together. A collaborative program will decrease the burden of tuberculosis amongst people living with HIV/AIDS and decrease the burden of HIV amongst TB patients.
The collaboration is also geared towards creating a formal working relationship between the TB and HIV/AIDS programs at every level that supports effective referral and sharing of information. It will also promote TB screening among all HIV positive people and promote HIV counselling and testing for all TB patients.
With the increased burden of TB among HIV/AIDS patients, Dr Ombeka says there are challenges facing the health practitioners as well as the sector as a whole. There is an increased workload for health workers, shortage of staff and staff motivation and limited infrastructure to offer testing.
The TB/HIV activist, Ms Chesire, concludes, `TB has become the major killer among people living with HIV/AIDS. This is the time that we have to conduct treatment literacy among the people affected, so that at the end of the day we may decrease the burden of TB among people living with HIV. TB is manageable, preventable and curable. Together we stand to fight TB`
* SOURCE: IPP Media
In recent years, the number of people with active Tuberculosis has increased where there is a large population of people infected with HIV. Experts say TB and HIV are like twins more especially when the duo affect one person. MATILDA KASANGA explains the symbiotic relationship between the two diseases and methods of treatment.
`I have been living with HIV for the past 10 years but I am now on ARVs and my CD 4 is 432.
It was a great challenge when I got to know that I had TB of the chest, knee and lymph nodes in the year 2000. Time seemed no longer to be on my side then. Coupled with weight loss, loss of appetite and night sweats, it was my worst time when they were not able to diagnose my TB.
My doctor then decided that I start my ARVs with my TB treatment - my CD4 count was 30 at this point in time. This led to a paradoxical reaction that complicated my recovery and I ended up staying in hospital for a period of seven months` says Lucy Chesire a TB/HIV advocate from Kenya.
Chesire continues: `During the same time, I was able to undergo three operations : one on the neck and two on my left leg. When I got out of hospital, I weighed about 48 kilos and I had to use crutches for a period of three months. It wasn’t easy.`
`I was able to recover and today my experience with TB has given me an opportunity to make my voice audible and advocate for TB and more so for the combination of TB and HIV programmes so that at the end of the day, since we are dealing with two diseases in one patient, we can be able to decrease the burden and give the person living with HIV a chance to get better treatment.`
The case of Selina illustrates that although she is infected with HIV, her TB has been cured.
Selina , a 30 year old mother of four who lives in Makambako, is a living example of proof that TB treatment is remarkably effective in people living with HIV.
‘I was married at the age of 16, but left my husband after giving birth to my second child because of his alcohol problem. I was afraid of him so I came to stay with my mum. Life was so hard and I had no other way to earn a living other than selling sex. ` When her baby was only four months old, Selina started to become sick with a cough , headache fever and chest pains,
She was taken to the hospital where she was diagnosed with TB. She returned home and was treated as part of the home-care services conducted by health workers and many volunteers offering support to People Living with HIV/AIDS. The health workers from the home- based team counselled her on the need to go for HIV testing.
She was found HIV positive but she says she was not entirely shocked as she knew her background quite well. People told her that there was no point in her having TB treatment because she would die of AIDS anyway, But Selina did complete her treatment and made a full recovery like Ms Chesire.
She even put on weight, and it is more than four years since she was diagnosed HIV positive and she is still leading a full and economically productive life. Chesire and Selina’s cases are just the tip of the iceberg. There are millions of women, men and children dying of TB worldwide, while the disease is preventable and curable.
There are nearly 42 million men, women and children living with HIV in the world today, more that 95 percent of whom are in the developing world where the highest rates of TB infection are found. More than 11 million are dual infected with TB and HIV.
It is an indisputable fact that the number of people with active TB has been observed to increase where there is a large number population of people infected with HIV. According to Dr Sitienei, the Kenyan TB-HIV National Coordinator, this increase in the numbers of TB cases can mainly be attributed to the HIV epidemic.
It is thought that HIV promotes the development of active TB in those with both previously and recently acquired tuberculosis infection. According to Dr. Sitienei, HIV destroys the cells that protect the body from getting infected with the TB bacillus which consequently attacks the body without hindrance. TB cases reported in Kenya have doubled over the years.
A study conducted on TB patients in 1994 showed that 40-60 percent of TB patients also had HIV. In some areas, the HIV sero prevalence in TB patients is as high as 92 percent. He says HIV also increases the risk of recurrent TB in those who have received recommended TB treatment regimes and been cured. This in turn increases the risk of TB transmission to the general community, Dr Sitenei says.
Although Kenya is facing a high TB burden, which is fuelled by the concurrent HIV epidemic, the majority of TB patients are not offered HIV diagnostic and testing and counselling and are therefore not aware of their HIV status. Similarly, many people living with HIV/AIDS have no access to an essential package of care and screening for TB and TB preventive therapy where appropriate.
He says an HIV positive person has a 50 percent chance of developing TB in his lifetime.
Impact of HIV on TB
The impact of HIV on TB is huge. It increases TB burden, morbidity and mortality. Dual stigma for both TB and HIV is common. Many suspected TB patients are reluctant to present themselves for screening because they fear that they will be labeled as having HIV/AIDS if found with TB.
Of further importance, says Dr Sitinei, the growing numbers of TB cases are due to the worsening socio-economic conditions, increasing urbanization with deteriorating urban infrastructure. HIV is the most significant cause of the dramatic rise in TB from the mid 1980s onwards.
Today TB is the single biggest killer of people infected with HIV. `The presence of TB greatly reduced the quality of life and ability to live, among people who are HIV positive. If their TB is not effectively treated, they have a high likelihood of dying within a few months,` says Dr Sitinei.
In Kenya, it is estimated that over the last ten years, there has been a ten-fold increase of TB cases which may be attributed to HIV/AIDS. In Kenya, since last year, the country has introduced a policy whereby every person who comes for TB diagnosis is also advised to undergo an HIV test in order to facilitate easy treatment in case he tests positive.
If I have TB does it mean that I have HIV/AIDS? Over the last ten years, many people have been asking this question simply because they suspect that once one has TB, one is automatically infected with HIV.
`If you have TB it doesn’t mean you have HIV/AIDS, ` says Dr. Vicent Ombeka, the Nairobi Provincial Tuberculosis’s and Leprosy Coordinator. He says it is not always that a person with HIV/ AIDS has TB.
Dr. Ombeka says there is a need for HIV/AIDS and TB programmes to work together. A collaborative program will decrease the burden of tuberculosis amongst people living with HIV/AIDS and decrease the burden of HIV amongst TB patients.
The collaboration is also geared towards creating a formal working relationship between the TB and HIV/AIDS programs at every level that supports effective referral and sharing of information. It will also promote TB screening among all HIV positive people and promote HIV counselling and testing for all TB patients.
With the increased burden of TB among HIV/AIDS patients, Dr Ombeka says there are challenges facing the health practitioners as well as the sector as a whole. There is an increased workload for health workers, shortage of staff and staff motivation and limited infrastructure to offer testing.
The TB/HIV activist, Ms Chesire, concludes, `TB has become the major killer among people living with HIV/AIDS. This is the time that we have to conduct treatment literacy among the people affected, so that at the end of the day we may decrease the burden of TB among people living with HIV. TB is manageable, preventable and curable. Together we stand to fight TB`
* SOURCE: IPP Media
posted by AIDS-Care-Watch at 7:52 am
0 Comments:
Post a Comment
<< Home