Despite the existence of effective medical treatments, tuberculosis (TB) is the leading cause of death for HIV-positive people globally. Resource limitations hamper the diagnosis and treatment of tuberculosis in the poor countries where the vast majority of the world’s 40 million HIV-positive people live.
The global HIV and TB epidemics interact with each other in ways that create unprecedented public health challenges. HIV weakens the immune system, leaving the body more vulnerable to tuberculosis and other diseases. Coexisting TB and HIV epidemics fuel each other in a vicious cycle, greatly worsening the impact of both.
Tuberculosis Infection and Disease
Active TB disease of the lungs is spread in bacteria-laden droplets through the air. TB infection occurs when the bacteria, Mycobacterium tuberculosis, enter a person’s body, usually through the lungs. Infection, however, is not the same as active disease. An infected person can carry the bacteria in latent form for years and most will never develop the disease. Latent TB cannot be spread to other people.
TB only becomes dangerous if the bacteria emerge from latency and begin attacking the body. Active TB disease manifests primarily in the lungs, but it can also attack other organs, a condition known as extrapulmonary TB. People with weakened immunity—the hallmark of HIV—are at far greater risk of developing active TB disease.
The most common way to diagnose TB is through sputum smear microscopy—a microscopic examination of discharge from the patient’s lungs that a person coughs up. But an infected person’s sputum may not contain enough TB bacteria for TB disease to be detectable. Globally, only 19% of TB cases are detected by sputum smear microscopy.
TB is often more difficult to diagnose in HIV-positive people than HIV-negative people. The sputum of an HIV-positive person usually contains a lower concentration of TB bacteria, which makes it harder to detect. Chest X-rays, when available, may aid in diagnosis. Neither sputum smear microscopy nor chest X-rays will detect extrapulmonary TB, which occurs more often in HIV-positive people than HIV-negative people.
Since TB can lead to illness and death much faster in HIV-positive people, any delays in diagnosing and finding appropriate treatment for HIV-positive people who have the disease can easily prove fatal.
Taken correctly, antibiotic drug regimens can cure most cases of TB. But if someone misses many doses, then the TB bacteria in that person’s body can evolve to develop drug resistance. Furthermore, if resistant TB spreads to other people then the drugs that triggered the resistance will not help the newly infected either. Drug regimens to treat resistant strains of TB are more costly, more complicated, require longer treatment duration, and have many more side effects.
Multidrug-resistant tuberculosis (MDR-TB) has become widespread in recent years. MDR-TB along with Extensively Drug Resistant TB (XCR-TB) which has even fewer treatment options are greatly hampering TB control efforts. The tools to quickly identify MDR-TB are not available in resource-limited settings, which means that a person diagnosed with TB via basic screening methods might be given drugs that will not work for their drug resistant TB. The delay of appropriate treatment—especially in persons with HIV—can lead to death.
There are major challenges to treating TB and HIV at the same time. Some TB drugs interfere with the effect of some HIV drugs. Taking some TB and HIV drugs together can produce side effects.
A significant number of HIV-positive people die from cases of TB disease that were either not diagnosed or were diagnosed and treated with drugs that did not help because their TB was drug resistant. It is therefore imperative for researchers to develop better, more affordable diagnostic tools and medical treatments to address the needs of people who have both TB and HIV—particularly those people living in resource-poor settings.The traditional compartmentalization of services for diagnosing and treating HIV and TB adds to the enormous challenge of serving people who have or are at risk for both diseases. Recognizing the urgent need for a more coordinated response to the two epidemics, the Hope Care Foundation’s TB, TB/HIV Project works to strengthen TB case detection, education and community-driven advocacy for better tuberculosis/HIV research, programs, and policy in Ghana and across Africa
HOPE CARE FOUNDATION TB, TB/HIV
The worldwide effort to control tuberculosis (TB) is failing. The ongoing spread of TB, including drug-resistant strains, presents a grave threat, especially to HIV-positive people in countries with high rates of both diseases.
HIV infection makes a person much more susceptible to TB disease, and it fuels the increase in TB cases, especially in sub-Saharan Africa. Furthermore, the spread of TB that is drug-resistant demonstrates the failure of established strategies for TB control. Due to the inadequacy of current TB diagnostic tools and treatments, as well as poor coordination of TB and HIV services, TB is the leading cause of death for HIV-positive people globally.
The Hope Care Foundation’s TB/HIV Project works to strengthen advocacy to improve treatment, education, and policy for people with TB and HIV. The project works to:
Training of Community Based Agents at a Village in West Akyem District in the Eastern Region of Ghana.
This was done in Collaboration with National Tuberculosis Control Program.
The project was funded by the Global Fund to fight TB, HIV and Malaria
Hope care foundation is a member of the International Union Against Tuberculosis and lung Disease. We have participated in the recent 41st Union Conference held in Berlin Germany together with the Program Manager of TB and the Director General of Ghana Health Service.
Worldwide, more than two billion people have been infected with hepatitis B virus (HBV); at least 350 million are chronically infected. An estimated 170 to 200 million people have been infected with hepatitis C virus (HCV); as many as 130 million are chronically infected. Both viruses can lead to cirrhosis, liver cancer, and liver failure.
Globally, six to nine million HIV-positive people are coinfected with viral hepatitis. End stage liver disease from viral hepatitis coinfection has become a leading cause of death among HIV-positive people in the Sub-Sahara Africa. HIV accelerates liver disease progression, and viral hepatitis is more difficult to treat in HIV-positive people.
The Hope Care Foundation’s Hepatitis/HIV Project collaborates with activists, community members, scientists, governments, and drug companies to make safer, more effective and less toxic treatment for viral hepatitis available. The Project forges coalitions with activists worldwide to demand universal access to hepatitis care and treatment.
The Hepatitis/HIV Project fights for research to address the unmet needs of people with viral hepatitis and HIV. It works with activists, community members, the Ghana Food and Drug Administration, and the African Medicines Agency to urge the pharmaceutical industry to study drugs and develop treatment strategies in “real life” populations, including people coinfected with HIV and viral hepatitis; Ghanaians and Africans; people with advanced liver disease; current and former drug users; and people unresponsive to existing treatments.
The Hepatitis/HIV Project works to assure that: