TB biggest threat to HIV positive

By, The World Today, July 24, 2007

ELEANOR HALL: Scientists at an international AIDS conference in Sydney have warned that tuberculosis is the biggest killer of HIV-positive people and that more needs to be done to eradicate it.

While technology for HIV testing has improved over the last quarter of a century, the test for TB has not changed for a century. Yet TB remains one of the world's biggest killers. Lucinda Carter has our report.

LUCINDA CARTER: Tuberculosis has been around for thousands of years, and according to the World Health Organisation, nearly three billion people worldwide carry the disease. While most of these people do not ever develop symptoms, in 2004 alone it killed more than 1.5-million people.

And many of those are HIV-positive. UNAIDS TB/HIV advisor, Dr Alasdair Reid, says those with HIV currently develop and die from TB at an alarmingly high rate.

ALASDAIR REID: A third of the world in fact is infected with tuberculosis, but only one in 10 of them go on to have TB in their lifetime. If you get HIV, that changes to one person in 10 a year, not over their lifetime but in one year, will develop tuberculosis.

LUCINDA CARTER: TB is especially common in poor or developing regions, where testing and treatment for the disease is all but ignored. To draw attention to the issue, South African photographer and artist Damien Schumann has created a work called The Shack which is a life-size replica of a shanty dwelling filled with photographs showing the plight of families and people affected by HIV and TB.

DAMIEN SCHUMANN: The Shack has been incredible especially internationally because what we've been able to do with that is we give the viewer, like so many people who don't have the opportunity to come into the townships, with The Shack, we've got the opportunity of bringing the townships to them.

LUCINDA CARTER: Currently, the Asia Pacific region has one of the fastest growing epidemics of HIV in the world. But UNAIDS' Dr Alasdair Reid says good management of tuberculosis in that region will help these sufferers.

ALASDAIR REID: Asia Pacific has done really well in tuberculosis control. Globally, the Western Pacific region is the first to reach their international TB control targets and everybody thinks, "well TB is done and dusted", and that's not the case. And so, we can't take our eye off the ball, we have to keep our focus on major killers like tuberculosis.

LUCINDA CARTER: Organisers are hoping to take The Shack on the road, heading next to Canberra to get the attention of federal politicians. Visiting The Shack display in Sydney today, Dr Reid says he hopes it will encourage more funding of research into TB because that disease plays such an important role for HIV sufferers.

ALASDAIR REID: We really do have to spend more money on tuberculosis. We're dealing with drugs that are over 40 years old, there's been no new TB drugs for over 40 years, and the test that we use for tuberculosis is over 120 years old, and it's not very good in people living with HIV. So, we need urgent investment in research, and that's our main reason for bringing The Shack to this conference, it's to raise awareness amongst the HIV research community of the plight of tuberculosis.

ELEANOR HALL: That's United Nations' TB/HIV advisor, Dr Alasdair Reid, ending that report by Lucinda Carter.

Source: http://www.abc.net.au/worldtoday/content/2007/s1987003.htm

Malawi: Threat of Extensively Drug-Resistant TB a Reality!

By, Moses Kaufa, The Chronicle Newspaper, July 16, 2007

In Malawi, Tuberculosis (TB) is closely linked to the HIV epidemic. Of the 28,000 cases of TB reported in the year 2005, approximately 70% of the patients tested HIV positive.

Although TB can be cured, the recent surfacing of an Extensively Drug Resistant-TB (XDR-TB) in South Africa is cause for concern.

With the current official rate of 14% HIV infection in Malawi and the link between HIV and TB, the need to put TB firmly on the political agenda of the country has become more necessary and urgent.

The government, through the Ministry of Health and the National TB Control Programme has committed to making sure that there a plan in place to respond effectively should any cases of XDR-TB surface in Malawi.

Advocacy, Communication and Social Mobilization (ACSM) an initiated component of the Malawi National TB Control Programme, seeks to create awareness, facilitate community involvement and participation and promote activities that will inform the public on the importance of adhering to treatment and medical advice for Tuberculosis in an effort to avoid the possible development of the fatal, Extremely Drug Resistant TB (XDR-TB).

Henry Chimbali, the Communications Officer of the National TB Control Program, ACSM has embarked on an advocacy campaign involving activities designed to place TB high on the political and development agenda.

The campaign also aims to increase financial and other resources on a sustainable basis as well as hold authorities to account. Additionally, the campaign seeks to ensure that pledges are fulfilled at the local level.

A major and very important part of the campaign is to prevent the possible development of the deadly XDR-TB in Malawi.

Reports indicate that XDR-TB probably developed because cases of normal TB are not treated properly. TB that is not effectively treated will resurface with resistance to the drugs used in the treatment and become Multi Drug Resistant - TB (MDR-TB). Concerns are high that XDR-TB could develop if patients are not aware of the importance of following the strict medical regime necessary to treat MDR- TB.

Records indicate that no one knows yet exactly how many cases of XDR-TB exist but surveillance shows that countries most affected by TB are those that are poor.

Chimbali told Health Check that XDR-TB mostly develops in patients who at one time used the drugs for other ailments or if they had defaulted in the treatment of TB.

However, the infection of XDR-TB is transmitted in the same way as the standard TB.

He says the intervention embarked on by ACSM seeks to prevent any possible occurrence of XDR-TB in this country and the further spread of infections should it occur.

"The program will be looking at adherence and compliance of treatment. This will be achieved by ensuring that all TB patients are under closely supervised treatment and all health workers have adequate knowledge on TB treatment guidelines. There will be a need to engage more health care providers in TB treatment monitoring, strengthening treatment monitoring systems at all levels and intensifying proper diagnosis of all TB suspect cases," Chimbali said.

He said the program is also focusing on prevention and control of the transmission of XDR-TB to health workers and the public.

"This will be achieved through early diagnosis of all TB treatment failures, relapses and tracing of all treatment defaulters and the establishment of special treatment centers for XDR-TB," said the Communications Officer.

XDR-TB is said to be very difficult to treat as it involves a regime that lasts for a long period of time. Drugs to treat the infection are extremely expensive making access to treatment of XDR-TB impossible for many under-privileged people.

Being diagnosed with the infection can be potentially fatal and many people risk losing their lives if diagnosed with the infection because they cannot afford to access treatment.

"Symptoms of XDR-TB are the same as those of any kind of tuberculosis; the only difference is that the particular mycobacterium cannot be killed by any drugs we have today. XDR-TB can only be determined in laboratories, but results take 6-16 weeks to obtain. The treatment is expensive because you need experts to handle the patient who will need to be quarantined," said Chimbali.

During the last decade there has been an increase of TB infections as an opportunistic infection in people with HIV because of their weakened immune systems. This is causing concern in the light of XDR-TB surfacing because interventions such as advocacy, communication and social mobilization in the prevention of the XDR-TB in Malawi, may be challenged in cases where people living with HIV are also found with Tuberculosis.

In an interview, HIV/AIDS Coordinator for Likuni Voluntary Counseling and Testing (VCT) Center, Joe Kamalizeni said one of the guidelines that helps to tell which stage a patient has reached is whether the patient has TB or has been treated for TB in the past.

"Any patient who has had Tuberculosis treatment and has HIV is placed on Stage 3 of the HIV infection and automatically goes on to Antiretroviral therapy," Kamalizeni confirmed.

Chimbali concurs and adds that being HIV positive and diagnosed with TB, the patient is placed on the first course of TB treatment that is combined with ARVs about two months later.

"The two months period is provided to avoid drug reaction which occurs when two types of drugs, Refampicin and Nevirapine are combined," he further adds: "In the first regimen of TB treatment there is a higher level of Rifampicin, which is lowered in the preceding regimen making the body to response favorably to ARV treatment."

He said that all TB patients who are HIV positive are first given Cotrimoxazole (Bactrim) before the next assessment, which determines the next stage for ARVs.

However, while normal TB can be treated with first line antibiotics, MDR-TB can be treated with two classes of second-line drugs, XDR-TB cannot be treated effectively with anything.

TB being one of the opportunistic infection related to HIV/AIDS, there is concern about the development of XDR-TB

Government, however, says people should not be worried as it is taking all steps possible to ensure that the localized TB treatment should include the advanced medication which targets the resistant ailment.

Principal Secretary for HIV/AIDS and Nutrition, Dr Mary Shaba told Health Check, "Meanwhile government is setting up special treatment centers for XDR-TB patients to protect the uninfected people from infection."

Chimbali said any development of XDR-TB could be averted if regular TB is treated effectively. He said: "Meanwhile there are about 16% TB patients who are on Antiretroviral therapy in the country and if we succeeded in controlling the XDR-TB transmission, then the risk would not be there," confirmed the Communications Officer.

He said XDR-TB could be prevented the same way ordinary tuberculosis is prevented. Most healthy people do not get tuberculosis unless they are in very close contact with people infected with TB. Tuberculosis is spread through the air on droplets. Healthcare workers and people who are in close contact with TB patients need to wear protective equipment such as masks. People in the first two weeks of tuberculosis treatment should cover their mouth when coughing and dispose of used tissues.

The World Health Organization (WHO) also recommends that healthcare workers should know their HIV status in order to avoid putting themselves at risk and if diagnosed with TB, strictly adhere to the treatment regime.

It is thought that drug resistant TB has arisen from TB that has been incompletely or improperly treated. People living with HIV/AIDS should be given a TB test, and if found to be TB positive, should start TB treatment before the disease begins to show.

According to World Health Organization, the likelihood of contracting XDR-TB is still pretty rare and in general, healthy people will not develop TB. WHO does not recommend against travel to any of the countries with tuberculosis of any kind. Healthcare workers, however, should take care to follow proper procedure to protect themselves from TB infection.


Source: http://allafrica.com/stories/200707160868.html?page=2

What is tuberculosis?

By, Independent.ie, July 17, 2007

TUBERCULOSIS (TB) is a respiratory condition caused by infection by my cobacterium tuberculosis.

TB was a major public health problem in Ireland up until the 1950s, when improved living conditions and the availability of an effective vaccine and antibiotics reduced the prevalence and mortality rate of the disease.

At present there are approximately 400 cases reported annually in Ireland.

TB is a contagious disease. The bacterium is spread in the tiny droplets that come from an infected person when coughing or sneezing. When these droplets are inhaled into the lungs by another person, infection can develop, particularly in those with a weakened immune system.

It is estimated that a person with undiagnosed TB can infect 10 people each year on average. The typical symptoms of TB are persistent coughing, fatigue and weight loss.

Diagnosis can usually be made by chest X-ray and confirmed by taking a sample from the patient to determine the presence of the bacteria.

The mortality rate of TB is low (about three per cent in Ireland), when correctly treated by a combination of antibiotics. Although it is no longer universally used, the BCG vaccine is an important element in TB control, particularly when used in targeted groups.

TB occurs as an opportunistic infection in people infected with HIV. There is also a higher incidence of TB amongst immigrant communities. It is estimated that three million people die each year from the disease.


Symptoms:

Persistent coughing and sputum production. The sputum (saliva and mucus) may contain blood. Fever, fatigue, weight-loss and sweats.


Treatment:

Once contracted, TB is treated with a combination of three to four antibiotics for a period of up to six months. The choice of antibiotic may be varied to avoid drug resistance. Patient adherence to the complicated treatment regime can be poor – some patients may require intensive supervision.


Prevention:

The Bacillus Calmette-Guerin (BCG) vaccine is an injection of live, weakened bacteria that stimulates an immune response against the disease.


Source: http://www.independent.ie/health/questions-answers/what-is-tuberculosis-1038998.html

Burmese Migrants Vulnerable to Tuberculosis

By, Violet Cho, The Irrawaddy, July 16, 2007

My chest is very painful when I breathe” said Paw Baw, clutching her chest while lying o­n a wood bed at a clinic in Mae Sot, Thailand’s border town with Burma.

“If I had followed the advice of the doctor (taking a drug treatment for six months), my disease would be cured now,” she said, regretfully, lying down o­n the bed of the Mae Tao Clinic.

Paw Baw, a 37-year-old ethnic Karen, is o­ne of a growing number of tuberculosis (TB) patients diagnosed in the border area since last year. This is her second round of treatment.

“I felt better after I had taken medicine for several months,” she said. “Then I heard my eldest son was lured away to become a Karen soldier. I was so worried that I ran away from the hospital to find my son without finishing my treatment."

Thawat Sunthrajarn, the Thai Health Ministry’s director of disease control, said 58,000 tuberculosis cases have been reported so far this year in Thailand.

Two patients were confirmed with XDR-TB, a drug-resistant form, in the Mae Sot community along the border earlier this month. TB cases are likely to increase this year, according to officials.

Manoon Leechawengwong, the chairman of the Drug Resistant TB Research Fund at Bangkok’s Siriraj Foundation, said researchers started studying the drug-resistant form of TB in 2001 and had found 13 cases identified as XDR-TB, according to The Nation, an English language newspaper in Bangkok.

Burmese migrants are more vulnerable to outbreaks of tuberculosis than other nationalities and less likely to undergo full treatments, according to researchers.

Voravit Suwanvanichkij, a public health researcher at Johns Hopkins University, said “since migrants (Burmese) are often impoverished, illiterate, discriminated against, fearful of arrest—since most are undocumented— they consistently have a far higher default rate compared to Thais.”

Voravit said XDR-TB usually arises when patients get inappropriate medicines or fail to complete their treatment courses.

Burmese patients who fail to complete treatment regularly appear at the Mae Tao Clinic, said Mu Ni, a TB specialist at the clinic.

“We always have cross-border migrant TB patients who come back to get treatment at the clinic,” Mu Ni said. But, because of the obstacles, “this community will be the group which carries the most resistance cases in the coming year.”

Last year, the Mae Tao Clinic sent about 600 suspected TB patients to the French aid agency, Medicines Sans Frontiers (MSF) in Mae Sot, to be tested. About half of the patients were confirmed to have TB.

Medicines Sans Frontiers (MSF), also known as Doctors Without Borders, is the world's leading independent organization for medical aid. MSF presently treats TB patients in 39 projects in 19 countries, including Thailand.


Source: http://www.irrawaddy.org/article.php?art_id=7618