. What is Tuberculosis?
Tuberculosis (T.B) or mycobacterium Tuberculosis (MTB) is mainly a disease of the poor. Combined with HIV, it causes quick and agonizing death. It is very much prevalent in poor and developing countries like South Africa and India. While HIV is transmitted through actual blood transfer, a simple cough or sneeze can spread T.B to others. Knowing the risk, human race is facing because of this dangerous disease, researchers have developed several medicines, the most important being B.C.G.
2. Effect of HIV on T.B:
In HIV infected persons, because of immunodeficiency, there is increased incidence of T.B by the following ways:
i) Reactivation of quiescent focus (Reactivation of healed VIRUS)
ii) Progression of recent infection to disease
iii) Super-infection
The degree of HIV induced immuno-suppression required to reactivate healed tuberculosis lesions appears to be less than that needed to help opportunistic infections, thus paving an easy route for dead virus to come back alive. Thus pulmonary T.B is often diagnosed first in persons who do not have other evidences of HIV induced immuno -suppression. Diagnosis of T.B or extra-pulmonary T.B, if found associated with an ELISA test is sufficient proof that the patient is having not only T.B but also AIDS.
3. Clinical Picture:
One of the greatest problems the physicians/social workers will face is that when T.B develops in earlier stages of HIV infection, the features of T.B will be indistinguishable from ordinary diseases as in non HIV people, thus posing a great danger to all concerned.
But there will be marked differences when T.B complicates the last stage of HIV infection just before or even after the onset of AIDS. The clinical and radiological findings also will differ in both the cases as follows.
The workers should be aware of the following:
i) Tuberculin test is often negative.
ii) Majority of cases present as extra pulmonary tuberculosis; in these cases, middle and lower lobes are affected more as compared to upper lobe with enlargement of par tracheal or hilar lymphnodes. (Readers may refer to a simple medical dictionary to know the meanings of medical terms mentioned herein)
iii) The biopsy of lymph nodes will show lack of cassation, and lymphocytes, giant cells and epithelial cells will be seen.
4. Treatment:
For pulmonary and extra-pulmonary T.B, short course chemotherapy should be given for minimum of 9 months which must include Rifampicin and INH. In case, the patient is not responding after six weeks, one more bacterial drug is to be added.
5. Some Facts About B.C.G Vaccination:
BCG (Bacillus Calmette-Guerin) is the vaccine against tuberculosis, mainly administered for children to prevent spread of this dreaded disease. Its effect will be for nearly 15 years. It should be avoided in case of infants with HIV. So children with HIV status (inherited from mother) stand chances of having T.B infection always. In case of children without HIV also this vaccination will be inactive after 15 years and people are prone to T.B infection. Thereafter other medicines are to be applied.
6. Policy of BCG Vaccination:
Non-clinical social workers have a great responsibility to explain to the common man the advantages of B.C.G and remove the misconceptions about the drug.
It is the policy of Government to give B.C.G vaccination for the new born children themselves as a protection against T.B. In India, when this vaccination was introduced
In 1950's there was stiff opposition to it. Celebrities like the elder statesman Rajaji (The first Governor General of India) vehemently opposed injection of this medicine to the newborn and he got good support from medical fraternity. But Government presented facts and figures before those who were opposed to BCG and now the vaccination is given to infants. However new-born babies who are found to have HIV infection due to Mother to Child Transmission (MTCT) are not given B.C.G.
In United States B.C.G is not given to children because T.B is not considered disease of most advanced Nations.
7. Treatment of T.B for HIV Infected People:
The following information is given for the benefit of workers who attend HIV/AIDS affected people with T.B.
British HIV association, an association of Physicians who are attending to HIV over the globe, through its newsletter has recommended the following treatment:
In patients with HIV, treatment for the HIV should be delayed until TB treatment is completed, if possible. The current UK guidance (provided by the British HIV Association) is:a. CD4 count over 200: delay treatment until the six months of TB treatment are complete.
b. CD4 count 100 to 200 delay treatment until the initial two-month intensive phase of therapy is completec. CD4 count less than 100: The situation is unclear and patients should be enrolled in clinical trials examining this question. There is evidence that if these patients are managed by a specialist in both TB and HIV then outcomes are not compromised for either disease.
If HIV treatment has to be started while a patient is still on TB treatment, then the advice of a specialist HIV pharmacist should be sought.
8. Responsibilities of Physicians and Social Workers Who Attend to AIDS/ T.B Patients:
The responsibility of Physicians and Social workers, who attend to AIDS affected people along with T.B, is much more complicated than those who attend to people only with HIV. They stand the great risk of infection since T.B will easily spread through air. At present, there is no other precaution than hand gloves and masks to prevent spread of T.B.
They should consult the specialists and take enough precautions to prevent acquiring T.B infection. The job of those social workers is really commendable because they are working in an atmosphere of risk and permanent danger.8. Conclusion:In this article, we saw briefly, the relationship between T.B and HIV and their mutualaffinity. A short paragraph is devoted to the clinical picture associated with T.B with special reference to B.C.G. A brief outline of the treatment to be given at various levels of HIV viral strength was also given supported by report of British HIV Association. Finally, a piece of information about the conditions of Physicians and social workers who work with T.B patients is also given.
Tuberculosis (T.B) or mycobacterium Tuberculosis (MTB) is mainly a disease of the poor. Combined with HIV, it causes quick and agonizing death. It is very much prevalent in poor and developing countries like South Africa and India. While HIV is transmitted through actual blood transfer, a simple cough or sneeze can spread T.B to others. Knowing the risk, human race is facing because of this dangerous disease, researchers have developed several medicines, the most important being B.C.G.
2. Effect of HIV on T.B:
In HIV infected persons, because of immunodeficiency, there is increased incidence of T.B by the following ways:
i) Reactivation of quiescent focus (Reactivation of healed VIRUS)
ii) Progression of recent infection to disease
iii) Super-infection
The degree of HIV induced immuno-suppression required to reactivate healed tuberculosis lesions appears to be less than that needed to help opportunistic infections, thus paving an easy route for dead virus to come back alive. Thus pulmonary T.B is often diagnosed first in persons who do not have other evidences of HIV induced immuno -suppression. Diagnosis of T.B or extra-pulmonary T.B, if found associated with an ELISA test is sufficient proof that the patient is having not only T.B but also AIDS.
3. Clinical Picture:
One of the greatest problems the physicians/social workers will face is that when T.B develops in earlier stages of HIV infection, the features of T.B will be indistinguishable from ordinary diseases as in non HIV people, thus posing a great danger to all concerned.
But there will be marked differences when T.B complicates the last stage of HIV infection just before or even after the onset of AIDS. The clinical and radiological findings also will differ in both the cases as follows.
The workers should be aware of the following:
i) Tuberculin test is often negative.
ii) Majority of cases present as extra pulmonary tuberculosis; in these cases, middle and lower lobes are affected more as compared to upper lobe with enlargement of par tracheal or hilar lymphnodes. (Readers may refer to a simple medical dictionary to know the meanings of medical terms mentioned herein)
iii) The biopsy of lymph nodes will show lack of cassation, and lymphocytes, giant cells and epithelial cells will be seen.
4. Treatment:
For pulmonary and extra-pulmonary T.B, short course chemotherapy should be given for minimum of 9 months which must include Rifampicin and INH. In case, the patient is not responding after six weeks, one more bacterial drug is to be added.
5. Some Facts About B.C.G Vaccination:
BCG (Bacillus Calmette-Guerin) is the vaccine against tuberculosis, mainly administered for children to prevent spread of this dreaded disease. Its effect will be for nearly 15 years. It should be avoided in case of infants with HIV. So children with HIV status (inherited from mother) stand chances of having T.B infection always. In case of children without HIV also this vaccination will be inactive after 15 years and people are prone to T.B infection. Thereafter other medicines are to be applied.
6. Policy of BCG Vaccination:
Non-clinical social workers have a great responsibility to explain to the common man the advantages of B.C.G and remove the misconceptions about the drug.
It is the policy of Government to give B.C.G vaccination for the new born children themselves as a protection against T.B. In India, when this vaccination was introduced
In 1950's there was stiff opposition to it. Celebrities like the elder statesman Rajaji (The first Governor General of India) vehemently opposed injection of this medicine to the newborn and he got good support from medical fraternity. But Government presented facts and figures before those who were opposed to BCG and now the vaccination is given to infants. However new-born babies who are found to have HIV infection due to Mother to Child Transmission (MTCT) are not given B.C.G.
In United States B.C.G is not given to children because T.B is not considered disease of most advanced Nations.
7. Treatment of T.B for HIV Infected People:
The following information is given for the benefit of workers who attend HIV/AIDS affected people with T.B.
British HIV association, an association of Physicians who are attending to HIV over the globe, through its newsletter has recommended the following treatment:
In patients with HIV, treatment for the HIV should be delayed until TB treatment is completed, if possible. The current UK guidance (provided by the British HIV Association) is:a. CD4 count over 200: delay treatment until the six months of TB treatment are complete.
b. CD4 count 100 to 200 delay treatment until the initial two-month intensive phase of therapy is completec. CD4 count less than 100: The situation is unclear and patients should be enrolled in clinical trials examining this question. There is evidence that if these patients are managed by a specialist in both TB and HIV then outcomes are not compromised for either disease.
If HIV treatment has to be started while a patient is still on TB treatment, then the advice of a specialist HIV pharmacist should be sought.
8. Responsibilities of Physicians and Social Workers Who Attend to AIDS/ T.B Patients:
The responsibility of Physicians and Social workers, who attend to AIDS affected people along with T.B, is much more complicated than those who attend to people only with HIV. They stand the great risk of infection since T.B will easily spread through air. At present, there is no other precaution than hand gloves and masks to prevent spread of T.B.
They should consult the specialists and take enough precautions to prevent acquiring T.B infection. The job of those social workers is really commendable because they are working in an atmosphere of risk and permanent danger.8. Conclusion:In this article, we saw briefly, the relationship between T.B and HIV and their mutualaffinity. A short paragraph is devoted to the clinical picture associated with T.B with special reference to B.C.G. A brief outline of the treatment to be given at various levels of HIV viral strength was also given supported by report of British HIV Association. Finally, a piece of information about the conditions of Physicians and social workers who work with T.B patients is also given.