This story is from December 1, 2016

‘TB is one of the biggestkiller of AIDS patients’

While AIDS no longer remains a deadly disease as it can now be dealt with effectively with right treatment, it continues to be a dreaded disease as a large number of people still die due to the many associated infections like tuberculosis that come with the syndrome.
‘TB is one of the biggestkiller of AIDS patients’
(Representative image)
NAGPUR: While AIDS no longer remains a deadly disease as it can now be dealt with effectively with right treatment, it continues to be a dreaded disease as a large number of people still die due to the many associated infections like tuberculosis that come with the syndrome. Doctors however say that with proper awareness and guidance from the treating physicians AIDS has become a more manageable syndrome.
Though no specific data is available in the country on HIV positive persons dying due to tuberculosis, TB is said to be one of the biggest killer of AIDS patients.
Dr Ashutosh Somalwar, associate professor of medicine at Government Medical College and Hospital (GMCH), told TOI that HIV and tuberculosis was a deadly synergy and HIV infection has led to resurgence of TB in India. “About 40% of HIV patients suffer from TB as a co-infection with TB in India. HIV infection reduces general immunity of any person to a great extent and hence opportunistic infections like TB bacteria catch them easily. These patients are thus said to be immunocompromised,” he said.
Dr Somalwar said that the HIV infected patients can suffer from pulmonary (lung), extra pulmonary (organs other than lungs), atypical forms of TB and multi-drug resistance TB. Patients with higher immunosuppression (whose CD4 count is less than 200) atypical forms of TB like thoracic lymphadenopathy and lower lobe lung involvement are seen more often.
“HIV-TB co-infection can lead to increased death rate and hence all patients of HIV should be screened for TB and vice versa,” said Dr Somalwar. However, the treatment of TB in HIV patients is similar to the non-HIV cases. But in these patients, the treatment needs to be started at the earliest. After a few weeks of anti-TB drugs, patient is put on anti-retro-viral therapy or ART is started after patient stabilizes with these medicines. All HIV infected persons with TB must be put on ART irrespective of CD4 count. ART drug treatment needs some modification in patients who are receiving anti-TB treatment.
Dr Somalwar said that the multi-drug resistance TB in which the patient does not respond to the drug regime commonly given to patients poses other kinds of problems in HIV patients. All patients with HIV-TB co-infection should be tested for anti-TB drug resistance. If resistance is found, patient may require second line of anti-TB treatment and this situation can lead to higher death rates.
‘Treat AIDS patients without any bias’

HIV infection may not be as dreaded as it was about three decades back, yet AIDS patients need to be dealt with much differently than any other disease. These persons need to be treated without being judgemental or biased. Also, unless the treating doctor, be it from a government set-up or a private practitioner, maintains confidentiality about the patient as they are still not comfortable with being labelled as a HIV positive or AIDS patient.
Speaking to reporters on the eve of the World AIDS Day on Wednesday, Dr Nitin Shinde, consultant, infectious diseases at Wockhardt Hospital, said that the treating doctors must have a very positive and neutral approach, both for treatment of the syndrome as well as the patient as an individual.
“While South Africa begins clinical trials on HIV vaccine and AIDS becomes more closer to being a treatable syndrome, HIV infections remain grossly unreported in India. This is because mostly only the patients from government hospitals are part of the statistics,” said Dr Shinde.
Dr Shinde said one of the good things that has happened with AIDS is that its treatment has become much cheaper. “The treatment at one time used to cost as much as Rs25-30,000 a month. Now in private set-up it costs Rs2,000 a month,” he said.
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