HIV/AIDS is an incredibly complicated and widespread issue in terms of global health. It affects people all over the world, rich and poor; carries persistent stigmas; and is associated with a host of opportunistic infections. Drugs and treatment regimens are constantly being reexamined and often redefined. There are any number of ways to address the challenges that an HIV epidemic presents to the global population, but there is one in particular that merits specific acknowledgement. An increasingly important part of the developing world’s fight against HIV/AIDS is the simultaneous management of tuberculosis.
According to the WHO, TB is a leading cause of death amongst HIV-positive patients through opportunistic infection, coinfecting approximately one-third of people with HIV worldwide, and killing nearly 50% of those with AIDS. In countries with high rates of HIV infection up to 80% of patients may be coinfected with TB (when incorporating the developed world, the number still holds at a 30% global rate of coinfection). This stems from the fact that approximately one-third of the world’s population en masse is infected with latent TB. HIV infection proceeds to weaken the immune system thus leaving the patient vulnerable to developing active TB.
A large part of the problem is patient management, diagnostics, and treatment. Due to lack of funds, space, and medicine, NGOs, hospitals and clinics in the developing world often unintentionally promote coinfection yet much of it cannot be helped without increased monetary and physician availability. Generally, testing and treatment need to be increased exponentially. The CDC recommends that all patients infected with HIV receive tests for TB, and all patients testing positive for TB be given full courses of treatment, whether or not they show symptoms, to prevent the latent infection from become active thus becoming contagious. The WHO also confirms that an extremely important preventative treatment for TB is through ART begun at an early stage of HIV infection.
These goals, while ideal and rational, are not necessarily feasible in countries with limited resources. Many countries do not have the budget to obtain enough TB drugs, and, of course, ART is traditionally given to only those with drastically low CD4 levels. Many studies are currently being done that confirm the benefits of beginning ART at initial diagnosis of HIV, but this will inevitably prove to be quite expensive: lifelong treatment must continue for any number of years and scheduled interruptions have been yielding disastrous results.
Generally it seems that early, accurate diagnosis and directly observed treatment is the best and most effective option in regards to management of both HIV and TB. However, it is also important for policy-makers and healthcare practitioners to actively acknowledge the strong and definite link between these two diseases. Patient management should ensure that TB patients are quarantined separately from HIV patients as best as the setting allows. Treatment should be started as early as possible for both diseases and should be monitored to ensure medication is taken properly as developing MDR-TB while infected with HIV is exponentially more difficult to overcome. Most importantly, it is beneficial for international health organizations to form partnerships between those dealing with HIV/AIDS and those focusing on TB as neither can be managed effectively without consideration of the other.