Nhiễm
Lao và HIV
[AIDSPREVENTIONPROJECT] Action: TB-HIV co-infection
– a summary -
Bác sĩ Huỳnh Đỗ Phi
Tuberculosis (TB) continues to be not
only the most common opportunistic infection but also the leading cause
of death for people living with HIV (PLHIV).
The Asia-Pacific region is home to more than two-third of the world's
TB burden, according to the Global Tuberculosis Control report (see link
1 below) of World Health Organization (WHO, March 2008). More than eight
percent of the new TB infections are in PLHIV. More importantly, the vulnerability
of PLHIV to drug-resistant TB is significantly higher owing to their immune
suppression.
Directly-observed treatment short-course (see link 2 below) is the internationally
recommended TB control strategy that includes standardized case detection,
treatment and patient support. It requires consistent drug supply and
effective monitoring systems. According to WHO, drug resistant TB is a
symptom of poor programme performance of directly observed treatment short
course (DOTS).
Drug-resistant TB has been recorded in the world at the highest levels
ever according to the WHO report - Anti-Tuberculosis Drug Resistance in
the World, February 2008 (see link 3 below).
If we hope to change the outcome, and decrease the proportion of drug
resistant TB, doesn't the DOTS model need to be adapted or its implementation
improved? More of the same might only compound the TB drug resistance
threat. Countries in Asia-Pacific region are expanding coverage of DOTS
at record-breaking speed. In its shadow, drug resistance is also upping
the pace.
Unless we significantly improve the programme performance of DOTS and
respond effectively to prevent and control drug-resistant TB, especially
among PLHIV, how will we achieve the Millennium Development Goal on HIV/AIDS
– 'to halt and reverse the spread of the epidemic by 2015' and the Universal
Access commitment "for scaling up HIV prevention, treatment, care
and support with the aim of coming as close as possible to the goal of
universal access to treatment by 2010 for all those who need it."
Multi drug-resistant TB (see link 4 below) is defined as TB with resistance
to isoniazid and rifampicin, the two most powerful first line anti-TB
drugs. Multi drug-resistant TB (MDR-TB) patients have significantly poor
outcomes than patients with drug susceptible TB. Global estimates indicate
that about 5% of TB cases were of MDR-TB (about half a million MDR-TB
patients). About 50% of the world's MDR-TB cases are in India and China.
Currently treatment is available only to one out of ten MDR-TB patients
and 90% of MDR-TB patients cannot have access to treatment they need today.
Extensively drug-resistant TB (see link 4 below) is virtually untreatable
and likely to emerge where second-line anti-TB drugs are widely and inappropriately
used. XDR-TB is more expensive and difficult to treat than MDR-TB and
outcomes for patients are much worse with mortality rates very high.
Transmission of TB, especially the drug-resistant strains is more likely
to take place where PLHIV congregate. Healthcare settings, for example
those for anti-retroviral (ARV) delivery, is one such place where improper
infection control can put PLHIV at risk of contracting TB. Improving infection
control in congregated settings (like hospitals/ clinics, prisons) is
clearly vital, doable and potentially life saving.
Developing laboratories to provide rapid diagnosis of anti-TB drug-resistance,
particularly for PLHIV, is of utmost importance to improve TB responses.
Most countries in Asia-Pacific, even don't have adequate number of drug-susceptibility
testing laboratories to diagnose MDR-TB or XDR-TB, forget about treatment
facilities!
Not only more and better TB drugs and diagnostics in the public sector
are urgently needed but also better strategies to make TB prevention and
treatment programmes work more effectively especially for PLHIV.
It will be vital to hear from those on the frontlines fighting TB and
HIV in Asia and the Pacific to share their experiences.
Bs Huỳnh Đỗ Phi
