the interaction between tb and hiv
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Anna Grinsted
Overview of TB and HIV Evidence of interaction
Epidemiological, clinical and cellular levels Implications Conclusions
Mycobacterium tuberculosis 2 billion people - roughly one-third
of the world population - are infected Primary infection most commonly
respiratory Typical presentation = Productive
cough, weight loss, fever, night sweats, fatigue, loss of appetite.
Transmitted by respiratory droplets Infectious dose = 1-10 bacilli Destructive effects entirely due to
hypersensitivity reaction of host
• Over 40 million people are infected worldwide
• 3 million deaths/yr
• HIV-1 (and HIV-2)
• enveloped RNA Retrovirus
• Transmission: sexual, blood-borne, perinatal.
Worldwide TB Incidence (2009)
25% of deaths of people living with HIV are
attributed to TB
In Africa:50% of those with HIV
develop TB,80% with TB are HIV positive
Co-infection increases morbidity and mortality
Lifetime TB risk in immunocompetent persons is 5-10%, but in HIV +ve individuals, the annual TB risk is 5-15%
HIV is the most powerful known risk factor for reactivation of Latent to active TB
Reduced generation time
IL-1beta IL-6 IL-8 GMCSF...enhances viral replication
synergistic reduction in macrophage viability
Macrophage
DOTS = Directly Observed Therapy, Short course
HAART
3 I’s strategy— Intensified case finding, Infection control, Isoniazid antibiotic prophylaxis
All people living with HIV should be evaluated forTB at the time of initial HIV diagnosis and during follow-up.
HIV testing should be considered in new cases of TB.
Co-ordination of services Multidisciplinary approach
Research How to combine services Diagnostic tests for TB in the immunocomprimised How to combine treatment Prophylaxis
High index of suspicion Difficult diagnosis in immunocompromised
Infection Control Don’t wait for a positive culture to isolate!
Drug Resistance DR-TB, MDR-TB, XDR-TB
See TB ---- think HIVSee HIV --- think TB!
• TB and HIV interact on many levels and act in synergy, resulting in increased morbidity and mortality• There are considerations for both the individual and for public health•There are implications for clinical practice and research• A co-ordinated approach is required
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online http://www.who.int/tb/challenges/hiv/en/ Pictures available from:
medicineworld.org, kashmirnewz.com, http://www.labgrab.com/users/labgrab/blog/you-can-see-lot-just-looking-yogi-berra_id=884, http://gamapserver.who.int/mapLibrary/Files/Maps/HIVPrevalenceGlobal2006.png, http://gamapserver.who.int/mapLibrary/Files/Maps/TBincidence_2009.png
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