the interaction between tb and hiv
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Anna Grinsted
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Overview of TB and HIV Evidence of interaction
Epidemiological, clinical and cellular levels Implications Conclusions
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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
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• Over 40 million people are infected worldwide
• 3 million deaths/yr
• HIV-1 (and HIV-2)
• enveloped RNA Retrovirus
• Transmission: sexual, blood-borne, perinatal.
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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
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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
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Reduced generation time
IL-1beta IL-6 IL-8 GMCSF...enhances viral replication
synergistic reduction in macrophage viability
Macrophage
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DOTS = Directly Observed Therapy, Short course
HAART
3 I’s strategy— Intensified case finding, Infection control, Isoniazid antibiotic prophylaxis
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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
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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
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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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Chaudhary M, Gupta S, Khare S, Lal S. (2010) Diagnosis of tuberculosis in an era of HIV pandemic: A review of current status and future prospects. Indian J Med Microbiol [serial online] 2010 [cited 2011 Jan 13];28:281-9. Available from: http://www.ijmm.org/text.asp?2010/28/4/281/71805
Ghebreyesus, T. A. et al (2010) Tuberculosis and HIV: time for an intensified response. The Lancet, Vol 375 Issue 9728, Pages 1757 - 1758, 22 May 2010
Habib AG. Ann Afr Med (2009) A clinical and epidemiologic update on the interaction between tuberculosis and human immunodeficiency virus infection in adults.rial online] 2009 [cited 2011 Jan 15];8:147-55. Available from: http://www.annalsafrmed.org/text.asp?2009/8/3/147/57236
Harsha Kumar HN, Gupta R. (2010) Risk of complications in HIV-TB co-infection: A hospital-based pair-matched case-control study. Indian J Community Med [serial online] 2010 [cited 2011 Jan 15];35:506-8. Available from: http://www.ijcm.org.in/text.asp?2010/35/4/506/74361
The Lancet Infectious Diseases (2010) The deadly synergy of HIV and tuberculosis. Leading Edge, The Lancet vol 10 July 2010 p441 Available online http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(10)70124-9/fulltext
Longmore, M. Et al (2007) Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) Oxford Handbook of Clinical Medicine 7th edition. P386-397 Oxford University Press, Oxford.
O’Conor, J. (2002) Pathology Second Edition. MOSBY, Elsevier Limited, Philadelphia. P105-7 and p267-8 Pathak, S. et al (2010) Effects of In Vitro HIV-1 Infection on Mycobacterial Growth in Peripheral Blood Monocyte-Derived Macrophages
Journal of Infection and Immunity, Vol. 78, No. 9 Sept. 2010, p. 4022–4032 WHO (2010) Priority research questions for TB/HIV in HIV-prevalent and resource-limited settings. WHO Publications, Geneva. Available
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