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Premium member Presentation Transcript HIV and Tuberculosis: HIV and Tuberculosis Dr. Anasua Bagchi Team Leader Strategic Planning & Head Technical Support Unit- TN & PuducherryEpidemiology of HIV-TB: Epidemiology of HIV-TBPowerPoint Presentation: ADULT HIV SEROPREVALENCE WORLDWIDEPowerPoint Presentation: Most TB cases are in India and China © WHO 2002 No Estimate 100000 - 999999 10000 - 99999 1000 - 9999 < 1000 1000 000 or morePowerPoint Presentation: Global trends in TB case notifications 90 100 110 120 130 140 150 160 170 1980 1985 1990 1995 2000 Standardized case notification ratePowerPoint Presentation: Estimated TB incidence vs. HIV prevalence in high burden countries 0 400 800 1200 1600 0.0 0.1 0.2 0.3 0.4 HIV prevalence, adults 15-49 years Estimated annual TB incidence (per 100K adults , 1999) HIV prevalence increases by 1% TB incidence increases by 26/100k/yrPowerPoint Presentation: Global Scenario 2 billion infected with M.Tuberculosis >40 million are HIV infected 11.5 million HIV/TB co-infected Over 90% of the dually infected reside in developing nations 1in 3 HIV positives are infected with TB 1in 3 people with HIV/AIDS dies due to TB About 9% of the global TB is attributable to HIV Sub-Saharan Africa shows an annual increase in TB cases in excess of 10% 1/3rd increase in TB in last five years is attributable to HIV.PowerPoint Presentation: Burden of HIV and TB In India 60-70% of PLWHA eventually develop TB Autopsy studies: 53% of AIDS death due to TB HIV Sero prevalence studies amongst tuberculosis patients in different regions of India shows – the prevalence rates varying from 0.4% - 28.1%. The estimated TB-HIV co-infection prevalence in india – 6% of TB patients with HIVPowerPoint Presentation: TREND OF HIV AMONG TB PATIENTS IN INDIAPowerPoint Presentation: Impact of HIV on TB A HIV positive person infected with M.tuberculosis has a 60% lifetime risk of developing TB whereas an HIV negative person has only a 10% risk of developing TB. TB is the most common serious opportunistic infection occurring among HIV-positive persons TB is the first manifestation of AIDS in more than 50% of cases in developing countries. In developing countries, tuberculosis is the major cause of mortality in PLWHA. – one out of every three people with AIDS worldwide.PowerPoint Presentation: Impact of TB on HIV TB shortens the survival of patients with HIV infection. TB accelerates the progression of HIV as observed by a six-to seven-fold increase in the HIV viral load in TB patients.PowerPoint Presentation: HIV AND TB : DOUBLE TROUBLE SUSCEPTIBILITY PRESENTATION DISEASE PROGRESSION MORTALITY TB HIVPowerPoint Presentation: HIV & TB INTERACTION HIV is the strongest Risk factor for Active TB disease Highest rates of Reactivation disease Extra - pulmonary TB Increase in absolute number of TB cases Shift in Youth Peak Prevalence of TB Increase in TB Mortality RatePowerPoint Presentation: RISK OF TB IN HIV PATIENTS To acquire latent TB To develop active TB once infected with M.tb. To become re-infected with a second strain of TB Increases with CD4 cell count declinePowerPoint Presentation: When to suspect HIV in TB Specific Herpes multidermatomal Recurrent genital ulcers Oral thrush Hairy cell leukoplakia Pruritus papular dermatitis Nonspecific Wt. Loss Chronic diarrhoea Retrosternal pain on swallowingPowerPoint Presentation: When to suspect TB in HIV Fever ,cough, wt.loss Night sweats Lymph node enlargement Common cause of PUO in HIV( Mycobacteremia) CXR –hilar /mediastinal adenopathy Miliary, pleural effusion CT scan – abdominal nodesPowerPoint Presentation: Issues Related to Diagnosis in HIV TB Dependent on AFB smear microscopy Sputum AFB smears more often negative Radiology – Nonspecific Atypical CXR findings May be negative Patients delay diagnosis because of stigma Clinical Presentation depends on degree of immunosuppression Higher proportion of sputum smear negative pulmonary disease (22- 64%) Mantoux test – of no value in diagnosisPowerPoint Presentation: Standard RNTCP –DOTS regimen are as effective among HIV-infected as among HIV-negative patients Case fatality is reported to be 3 fold high when the person is treated with the same drugs but not in a programme of DOTS. Relapse rate in HIV positive similar to HIV negative (3-5%) ANTI-TB REGIMEN FOR HIV-TB CO INFECTED PATIENTPowerPoint Presentation: GOI TREATMENT GUIDELINES Dec 2004 All HIV positive persons suspected to have TB should be diagnosed on the basis of sputum microscopy, following the RNTCP diagnostic algorithm All known HIV positive patients diagnosed with TB disease who have in the past never received antituberculosis treatment for more than one month (new cases) should receive Category One RNTCP regimen( 2EHRZ 3 /4RH 3 ) Patients who are known HIV positive, diagnosed with TB and have earlier been treated for TB (relapse/treatment after default/failure cases) should receive Category Two RNTCP regimen (2SEHRZ 3 /1EHRZ 3 /5EHR 3 )PowerPoint Presentation: TESTING AND COUNSELING FOR HIV IN TB TREATMENT SETTINGS WHO recommends HIV testing and counseling TB patients as best practice, standard of care for management of TB patients TB treatment settings are high-yield site for HIV testing and counseling for HIV prevention and care, even early in HIV epidemicPowerPoint Presentation: ANTIRETROVIRAL THERAPY AND TB Improved immune responses to TB with HAART Reduction in case rates of TB during HAART era HAART could reduce risk of primary infection, relapse and re-infectionPowerPoint Presentation: WHO Guideline In patients with HIV related TB- Priority is to treat TB Special emphasis on Sm positive TB ( The need to stop TB Transmission) HIV related TB can have ART and ATT at the same time- Careful evaluation necessary to judge when to start ARTPowerPoint Presentation: If a patient on ART develops active TB To use Rifampicin containing ATT under DOTS – Since Non Rifampicin Based ATT is known to be less effective. Best option would be to modify ART regimen so as to be compatible with Rifampicin based regimen- ZDV+3TC+EFV ZDV+3TC+SQV/r ZDV+3TC+ABC Following completion of ATT, the ART regimen can be continued , or changed – depending upon the clinical and immunological status of the patient ART should not be discontinued because of concerns of development of drug resistanceHIV-TB Programme Coordination: HIV-TB Programme CoordinationPowerPoint Presentation: Purpose of HIV-TB coordination To ensure optimal synergy between the two programmes for the prevention and control of both diseasesPowerPoint Presentation: VCTC/PPTCT Centre Identify suspected undiagnosed TB patients Refer for TB Investigations –DTC/MC/TB OPD MICROSCOPY CENTRE Sputum requisition slip Medical Officer Decides whether TB or not If TB Refers patient to DOTS centre Communicate information to VCTCPowerPoint Presentation: 83% 91% 23% 67%PowerPoint Presentation: 14% 91% 96% 81%PowerPoint Presentation: PROCESS OF REFERRAL FROM RNTCP TO VCTC Diagnosed TB pts. -RNTCP S/S suggestive of HIV infection or history of high risk behaviour of HIV infection VCTC Counsellor for Post-Test Counselling Referral Note Pre-Test Counselling VCTC Consent for HIV Patient goes back to the RNTCP Unit with the test results Diagnosed TB patients coming VOLUNTARILY Laboratory – Blood collected HIV Test Done Test ResultsPowerPoint Presentation: Tamil Nadu Referral Activity from RNTCP to ICTC 97% 10% 6% 95%Intensified TB Case finding at ART Centers: Intensified TB Case finding at ART Centers ICF now extended to all ART centers TB screening done at Pre-ART registration, Initiation of ART, and Routine follow-up visitsProvision of HIV care to HIV co-infected TB pts: Provision of HIV care to HIV co-infected TB pts Provision of CPT for co infected TB patients Reduces risk of many diseases Pneumocystis pneumonia Bacterial infections TyphoidPowerPoint Presentation: Challenges for Program: Treatment of Co-Infected Patients Patients with HIVTB require Co-trimoxazole prophylaxis, referral for CD4 testing and assessment for anti-retroviral treatment Physicians, health care personnel feel poorly equipped to manage HIV in periphery DOTs available near patient’s home, not HIV-related services Challenges: distance, travel, coordination between centres, managing AE, adherenceConclusion: Conclusion The overall goal is the reduction of TB related morbidity in PLHA while preventing further spread of HIV and TB in the populationPowerPoint Presentation: Thank You You do not have the permission to view this presentation. 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