HIV TB coinfection - perspectives from India

ABSTRACT

Introduction: HIV and tuberculosis (TB) are two of the most challenging infections faced by humanity and place immense burden on health care systems worldwide. Both HIV and TB impact one another’s progression.

Areas covered: HIV is the most important risk factor for progression of latent TB to active disease. TB is the most common cause of death among People Living with HIV (PLHIV). Timely detection of TB among PLHIV and screening for HIV among TB patients, early initiation of ART and ATT among coinfected persons, provision of CPT and TB Preventive therapy along with control of air-borne infection are some of the key activities to reduce morbidity and mortality among coinfected persons. Despite many challenges, the collaboration between two programs has yielded good results and globally more than 7.3 million lives of PLHIV have been saved globally through scale-up of collaborative TB/HIV activities since 2005. The review looked into key features of both programs that are the collaboration strategies and challenges that still need to be addressed.

Expert opinion: The overarching principle for effective implementation of collaborative activities is integration of the TB and HIV national programs right from policy making to service delivery and monitoring.

KEYWORDS:

• HIV TB integration collaboration
• HIV
• TB
• integration
• collaboration
• TB HIV collaboration national framework

Article Highlights

• HIV increases the risk of progression of latent TB infection (LTBI) into active TB disease by nearly twenty-fold. Similarly the risk of tuberculosis among PLHIV increases as immune suppression progressively increases.

• In South- East Asia region, an estimated 140000 people had HIV-TB coinfection in 2018 with an estimated mortality of 21000. Around 61% of notified TB cases knew their HIV status. Around 4.1% (76 585) of TB cases were found to be HIV positive.

• The clinical presentation of HIV associated tuberculosis is diverse and often atypical posing a diagnostic challenge. It depends largely on degree of immunosuppression.

• It is recommended that all TB patients and suspects should be offered HIV testing and counselling. Also all PLHIV should be screened for TB on all available opportunities. This requires good collaboration between two programmes.

• Treatment of TB in HIV positive and negative individuals in largely same. ATT should be initiated first followed by ART within 2 weeks to 8 weeks depending on severity of immune suppression.

• Globally there is a movement to end TB and HIV epidemics by the year 2030 under the UN’s Sustainable Development Goals framework and all countries committed to achieving these goals. Ending TB and HIV is possible, and for this adequate allocation of resources under ambit of Universal health care (UHC), joint planning, co-ordination and focused action from everyone is needed. .

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.