Co-Infection with HIV

Living with two enemies: Tuberculosis the leading cause of death among people with HIV

© Brendan Bannon

"I worry about giving MDR-TB to my family, but I have to take care of my children, so I have no choice but to live here with them."

Monica Juma, a widowed mother of five, is infected with both HIV and multi-drug-resistant TB. She takes more than 20 pills a day. She also receives a very painful injection each morning, six days a week and has to swallow granules mixed with lemon juice that upset her stomach. 

Living with two enemies: Twin epidemics of HIV and TB are spreading illness and death, especially in Africa. Today, an estimated 12 million people are co-infected with these diseases and more than two thirds of them live in sub-Saharan Africa. Without treatment, about 90% of people with HIV who become infected with TB will die within months of contracting the disease.

Battling the twin epidemics of TB and HIV
Most people infected by TB mycobacteria will not develop active TB as their immune response works to keep the disease dormant. But as a person’s immune system weakens, as is precisely what happens to people infected with HIV, the TB mycobacterium can activate and start to attack its host. When the immune system is weak, it is also much easier to contract the disease from other TB sufferers.
 
Because it’s harder to diagnose TB in people with HIV with a microscope, which is the most widely available testing method, the majority will go undetected until it is too late. Without adequate diagnosis, the disease continues to kill and spread at an alarming rate in regions already hit by a high prevalence of HIV. Resistant forms also spread easily in conditions where weak health infrastructure and weakened immune systems are both common.

MSF is working to integrate treatment of co-infected patients in Kenya

“Homa Bay TB clinic is the place in which co-infected patients are treated for both infections. Once the TB treatment is completed and therefore they are no longer co-infected the patients are transferred to the AIDS clinic. But this hasn’t been simple. The solution might seems obvious, but the method of treating separately was so ingrained, that it has taken us two years to manage to convince all the others actors involved.” Christine Genevier, head of mission, Homa Bay, Kenya.
 
By the end of March 2006 more than 5000 patients were being treated in the Homa Bay programme, of whom nearly 3000 were taking anti-retroviral tri-therapy (ART). In addition, 2000 patients had been diagnosed with TB and were being followed-up.

Read more

HIV-TB co-infection: The Failure to Act

Interview with Christine Genevier

Treatment of HIV co-infected patients much less successful
HIV has been fuelling the TB epidemic throughout Africa. In Lesotho, where MSF runs an HIV care project in a rural health centre, 221 patients started on TB treatment in 2006, 92% of whom were co-infected with HIV.

While MDR-TB might be deadly in 5-20% of HIV-negative patients, death rates of 66% have been reported among HIV-positive patients. One reason is that some of the drugs used to treat both conditions interact, reducing their effectiveness and may trigger serious side effects.

What needs to happen:

  • TB Treatments that don’t interact with antiretroviral treatment need to be developed.
  • TB diagnostic tools that are effective in people with HIV are urgently needed.
  • Integrated medical care of TB and HIV patients.

Read more

MSF and Tuberculosis

Diagnosing Tuberculosis

Treating Tuberculosis

Resistant Strains

Looking for New Tools