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TB-HIV
Because the HIV
infection weakens the immune system, people with TB infection and HIV
infection are at very high risk of developing TB disease. All HIV-infected
people should be tested for TB. If they have TB infection, they need
preventive therapy as soon as possible to prevent them from developing TB
disease. If they are diagnosed with active TB disease, they must take
medicine to cure the disease.
The increasing incidence of
HIV/AIDS may fuel the TB epidemic in the South-East Asia Region, which is the
second hardest hit by the HIV-epidemic following sub-Saharan Africa. That the incidence of both
diseases is highest in the economically productive age groups (15-54 years),
poses significant threats not only to health, but
also to the social and economic development in the Region.
Of the 39 million persons
estimated to be living with HIV in December 2003, more than six million were
in the SEA Region. TB is the single most life-threatening infection and the
leading cause of mortality among those with HIV infection. Between 2.5 and 3
million people are currently estimated to be infected with both HIV and TB,
and between 50 to 82% of diagnosed AIDS cases suffer from TB. Thailand,
Myanmar
and six states in India
have generalized HIV epidemics (prevalence of >1% among pregnant women). Indonesia
and Nepal
are at the stage of concentrated epidemics (>5% prevalence in high-risk
groups such as intravenous drug users in both countries, and among female commercial
sex workers in Indonesia).
Unlinked anonymous testing (UAT) for HIV among newly
detected TB patients has been undertaken in a few Member countries in the
Region. The prevalence has generally been reported at less than 1%. Seroprevalence surveys have indicated that the HIV-seropositivity among TB patients is estimated to range
from 0.1% in Bangladesh to 24% in Thailand (2003). Where
the local HIV prevalence is higher than the country average, for example
Chiang Rai in northern Thailand, the rate of HIV seropositive TB patients increased from about 1 per
100 000 in 1990 to over 50 per 100 000 in 2000. Simultaneously, the
TB-notification rates increased from about 50 per 100 000 in 1991 to
about 130 per 100 000 in 2000. TB-registry data from ChiangRaiProvincialHospital, which started
confidential HIV testing in October 1989, indicated a steady and rapid
increase in the number and proportion of HIV-seropositive
TB patients, from 1.5% in 1990 to 45.5% in 1994; by 1998, 72% of male TB
patients and 65.8% of female TB patients were co-infected with HIV. Data for
a similar ten-year period available from Pune, India showed that the
HIV seropositivity rate among newly diagnosed TB
patients had steadily increased from about 4% in 1991 to about 30% in
2001.
The extent of the epidemic of
TB/HIV in South-East Asia
will depend heavily on efforts to prevent and control both TB and HIV. If the
countries in this Region are to avoid the plight of sub-Saharan Africa, decisive steps must be taken
now to combat the dual epidemics.
Thailand
has taken a lead in collaborative interventions for TB-HIV and is extending
comprehensive services to the entire country; INH preventive therapy (IPT) is
available at 22 sites in the country. In India,
Indonesia,
Myanmar
and Nepal,
central level working groups and task forces on TB-HIV have been established
and national policies formulated. As of 2003, however, only Indonesia
and Thailand
had a national policy of HIV testing and counselling
of all TB patients. TB-HIV surveillance has been conducted at selected
sentinel sites in India,
Indonesia,
Myanmar
and Nepal.
Guidelines and training materials have been developed and pilot projects are
being initiated in these countries. Plans to scale up collaborative
interventions as part of regular programme
implementation by both TB and HIV programmes are
being developed.
 Strengthening
mechanisms for collaboration between national HIV/AIDS and TB programmes.
Assisting
countries with developing national policy, guidelines and implementation
plans based on internationally recommended TB-HIV policies and strategies.
Assisting
countries with preparing general health systems to deliver TB-HIV
interventions.
Strengthening
capacity to diagnose and manage HIV-associated TB including ensuring
essential standard of care.
Developing
mechanisms to regularly monitor and evaluate TB-HIV interventions and their
impact.
Intensifying
and expanding surveillance for TB-HIV in the Region.
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