Double Trouble: TB & HIV
“We needed to develop “delivery platforms” to treat tuberculosis and address the poverty that both puts people at risk for the disease and prevents them from being cured of it. With this airborne disease, good delivery systems prevent transmission–and that’s what public health is supposed to be all about.” -Paul Farmer
This year’s international observance of World TB Day, on March 24th, served as a consistent reminder that tuberculosis (TB) is far from being an antiquated, irrelevant disease. In places such as South Africa TB remains one of the main killers of youth, with almost 80% of country’s young adults already infected with TB and approximately 330,000 people infected with both HIV and TB last year alone. The HIV infection lowers the ability of the immune system to fight off disease, making those whom are HIV positive highly susceptible to TB infection and disease. The infection can then change from a dormant/inactive phase to the active disease during these times of lowered immune ability, labeling TB as an opportunistic disease. HIV positive patients are 30 times more likely to develop the TB disease than HIV negative patients; in fact, ¼ of all TB related deaths occur in people living with HIV. Approximately 13% of the worldwide cases of TB in 2012 were also HIV positive.
Pediatric TB and HIV have many of the same symptoms, including persistent cough, fever, and weight loss, all factors that make a positive TB diagnosis more complicated. Worldwide, children account for approximately 10% of all new global HIV infections. Several studies have correlated the dramatic impact that joint TB and HIV infection can have on children. A study produced from Ethiopia found that children who were jointly infected were approximately 6 times more likely to die, while another from Côte d’Ivoire found that children were 3.6 times more at risk. The main intervention for HIV positive TB patients is still the provision of antiretroviral treatment, and continual screening. World Health Organization (WHO) suggests the same treatment protocol for both HIV positive and negative individuals. There are ten vaccines and several others in development for the prevention of TB. Although TB remains a global health crisis, the annual rate of reduction is approximately 2%.
An example of an organization working to significantly treat and prevent TB is Partners in Health (PIH). With locations in Haiti, Lesotho, Peru, etc. and active representatives such as Dr. Paul Farmer and Dr. Mercedes Becerra, Partners in Health focuses around the structural barriers to the diagnosis and cure of tuberculosis and other diseases afflicting the poor. In children, TB disease can cause severe and quick health deterioration, thus, one of the most important aspects of addressing the issue of pediatric tuberculosis is the TB Contact Investigation strategy that involves a screening process of all a patient’s close contacts and treatment for active TB disease or dormant TB infection. Contact investigation greatly increases the chances that child contacts that are sick will be recognized as TB cases and treated promptly. Patients who suffer from both HIV and TB are treated in fully integrated clinics such as the one in PIH Lesotho, where the co-infection rate for HIV and multidrug resistant TB is almost 70%. HIV and TB are major global health and public health threats; understanding the way these diseases interact with one another on local and global levels is essential for the eradication of TB.
Venturini, E., Turkova, A., Chiappini, E., Galli, L., de Martino, M., & Thorne, C. (2014). Tuberculosis and HIV co-infection in children. BMC Infectious Diseases, 14 Suppl 1(Suppl 1), S5-S5. doi:10.1186/1471-2334-14-S1-S5