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HIV and tuberculosis in India

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Abstract

The global impact of the converging dual epidemics of tuberculosis (TB) and human immunodeficiency virus (HIV) is one of the major public health challenges of our time. The World Health Organization (WHO) reports 9.2 million new cases of TB in 2006 of whom 7.7% were HIV-infected. Tuberculosis is the most common opportunistic infection in HIV-infected patients as well as the leading cause of death. Further, there has been an increase in rates of drug resistant tuberculosis, including multi-drug (MDRTB) and extensively drug resistant TB (XDRTB), which are difficult to treat and contribute to increased mortality. The diagnosis of TB is based on sputum smear microscopy, a 100-year old technique and chest radiography, which has problems of specificity. Extra-pulmonary, disseminated and sputum smear negative manifestations are more common in patients with advanced immunosuppression. Newer diagnostic tests are urgently required that are not only sensitive and specific but easy to use in remote and resource-poor settings. Treatment of HIV-TB co-infection is complex and associated with high pill burden, overlapping drug toxicities, risk of immune reconstitution inflammatory syndrome (IRIS) and challenges related to adherence. From a programmatic point of view, screening of all HIV-infected persons for tuberculosis and vice-versa will help identify co-infected patients who require treatment for both infections. This requires good coordination and communication between the TB and AIDS control programs, in India.

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Abbreviations

DMC:

designated microscopy centre

HIV:

human immunodeficiency virus

ICTC:

integrated counseling and testing centre

IRIS:

immune reconstitution inflammatrory syndrome

NRTIs:

nucleoside reverse transcriptase inhibitors

NSAID:

non-steroidal anti-inflammatory drug

PCP:

Pneumocystis Jiroveci pneumonia

PGL:

persistent generalized lymphadenopathy

PI:

protease inhibitor

RNTCP:

Revised National TB Control Program

TB:

tuberculosis

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Authors and Affiliations

  1. Deptartment of Clinical Research, Tuberculosis Research Centre, Mayor VR Ramanathan Road, Chetput, Chennai, 600 031, India

    Soumya Swaminathan & G. Narendran

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  1. Soumya Swaminathan
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  2. G. Narendran
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Correspondence to Soumya Swaminathan.

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Swaminathan, S., Narendran, G. HIV and tuberculosis in India. J Biosci 33, 527–537 (2008). https://doi.org/10.1007/s12038-008-0071-2

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