Advances in the Diagnosis, Treatment and Control of HIV Associated Tuberculosis

Abstract

SummaryThere has been an increase in the number of published tuberculosis/HIV (TB/HIV) research findings in recent times. The potential impact of these findings on routine care has informed this review which aims at discussing current concepts and practices underpinning TB/HIV care and control. Any HIV infected person with a cough of any duration is currently considered a TB suspect. Preliminary results also show that the diagnostic yield of same day sputum samples (front loading) is comparable to two-day samples. Laboratory diagnosis is shifting from Ziehl-Neelsen (ZN) smear microscopy and solid culture to fluorescent microscopy, molecular tests and liquid culture. Concomitant TB/HIV therapy improves survival and WHO has recommended ART for all TB/HIV patients. Unless CD4 cell counts are less than 50 cells/µl, ART can be deferred until end of intensive phase. Evidence of survival benefit at high CD4 cell counts is still lacking. New TB drugs and treatment shortening studies are underway but so far no new TB drugs has been added to the current arsenal and treatment duration still remains six months or more. WHO has recommended the 3Is (intensified TB case finding, isoniazid prophylaxis and infection control) for TB/HIV control in addition to effective therapy, Antiretroviral therapy and TB vaccines. There has been immense progress in TB/HIV research, however optimal management of HIV-Infected TB patients, will require further research and appropriate translation of emerging evidence to policy and practice. IntroductionThe burden of tuberculosis (TB) among human immunodeficiency virus (HIV) infected persons continues to represent a major public health problem. Of the 9.4 million new TB cases reported in 2009, 1.1 million were HIV infected of which 380, 000 died (WHO Global Tuberculosis control report, 2010). Antiretroviral therapy (ART) reduces person and population risk of TB by 90% and 60% respectively (Lawn S et al., 2005, Badri et al., 2002. Unfortunately only 37% of TB/HIV patients who qualified to receive ART were initiated on ART in 2009 (WHO Global Tuberculosis control report, 2010). There has been an increase in basic, clinical and public health TB/HIV research, shedding new light on diagnosis, treatment and control of TB/HIV; hence those involved in the field of TB/HIV need to constantly update their knowledge in this field. The purpose of this review is to describe, discuss and summarize current concepts and practices in the diagnosis, treatment and control of HIV associated tuberculosis. Diagnosis of HIV associated tuberculosisTB symptoms: One of the major advances in the clinical diagnosis of TB/HIV has been the demonstration in number of studies that TB/HIV patients with cough should be tested for TB irrespective of the duration of the cough (Kevin et al., 2010), Ngadaya et al., 2009). In a study that evaluated the performance of different combination of TB symptoms, it was found that the best symptom combination included two predictors; fever of any duration in the previous 4 weeks plus cough of a...

Prevalence of pulmonary tuberculosis among casual labourers working in selected road construction sites in central Uganda

“…Several studies in Uganda have focused on the burden of TB among other risk groups, such as health workers and slum dwellers [15][16][17]. However, no study has been conducted among road construction workers in Uganda, despite the high occupational exposure and widespread use of silica-containing surfaces.…”

Risk Factors of Nevirapine Hypersensitivity Reaction among Human Immunodeficiency Virus-1 Infected Treatment Naïve Patients at Korle-Bu Teaching Hospital

“…Nevirapine (NVP), a Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI) is widely used as the first-line treatment for HIV-1 infections in developing countries [2]. It is the preferred NNRTI antiretroviral regimen in pregnancy because of its proven efficacy in reducing mother-to-child transmission [3].…”