I was at a party a couple of months ago when I saw my friend Suzanne Marks, M.P.H., M.A., an epidemiologist with the Centers for Disease Control and Prevention (CDC). She had just finished a study on prevention of tuberculosis (TB) among persons with HIV infection. As revealed by the results of the study, there are several things that the HIV/AIDS community should be aware of when it comes to TB. However, before we get to those, let's go over the basics of TB.
There are two stages of TB. The first stage of TB is latent infection. TB infection can develop after someone inhales droplets sprayed into the air from a cough or sneeze by someone infected with active TB disease. TB infection takes place when the immune system can't arrest germs and granular tumors develop in the infected tissues. The usual site of the disease is in the lungs, but other organs may be involved. Persons who are infected with TB are not contagious and are not able to pass on the disease. Most people with uncompromised immune systems will heal from the infection with no further disease complications. TB infection is usually asymptomatic. In other words, there are no telltale symptoms to warn a person that they have TB infection.
It is only when a person is in the second stage of TB, active TB disease, that they are infectious. Active TB disease develops in immune systems that do not successfully heal the primary infection. TB disease may occur within weeks of primary infection, or may lie dormant for years before causing illness. Some of the symptoms that are seen in someone with active TB infection are: coughing, shortness of breath, sweating, fatigue, general discomfort, weight loss, paleness, joint pain, chills, night sweats, fever and swollen glands (lymph nodes, liver and spleen). The symptoms vary depending on which organ is affected.
According to Suzanne Marks, there are five basic things that the HIV/AIDS community should be aware of concerning TB:
- HIV-infected persons are at extremely high risk for TB infection if exposed to an infected person. There is literally an 800 times greater risk of TB transmission to an HIV-positive person.
- TB is curable and preventable if the infection or disease is identified.
- The treatment for TB infection is 70% effective in the prevention of TB disease. Either one drug is taken for six months or two drugs are taken for two months. These treatments help in preventing the development of active TB disease.
- If active TB disease develops, hospitalization is typical to prevent the spread of the disease to others until the infectious period is over. The infectious period usually lasts two to four weeks after the start of therapy. After the initial treatment is over, daily oral doses of antitubercular drugs are typically continued for six months to one year.
- TB is as curable in HIV-positive persons, as in those with uncompromised immune systems.
- Persons coming in contact with TB need to know their HIV status so they can pass on the information to their health care providers.
- It is important to provide information on HIV status to doctors because traditional TB tests are not reactive in HIV-positive persons because of the suppressed immune system. In these cases, different screenings are necessary for persons with HIV.
- Because of the effects on screening instruments, treatment for TB infection should be started when TB is suspected, regardless of what test results show.
- If the HIV status of a patient is not known, health care providers should offer voluntary HIV testing and counseling to help prevent the spread of active TB disease.
- HIV-infected persons need to be aware of the high risks associated with TB and the benefits of treatment.
- Health care providers should facilitate adherence to TB treatments for infection or disease by offering incentives and enablers (housing, transportation and directly observed therapy).
- Health care providers should make sure that patients understand the importance of taking the full course of the medications.
- When patients and providers are aware of the HIV diagnosis, they can work together to make sure that adequate screening and preventive therapy is provided as well as providing the patients with links to other necessary services such as antiretrovirals, protease inhibitors and other HIV medications.
If you would like to view the published text of the study, Missed Opportunities for Prevention of Tuberculosis Among Persons With HIV Infection -- Selected Locations, United States, 1996-1997, go to http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4930a1.htm. Further information on HIV and TB can be found at http://www.thebody.com, or http://www.thebody.com/treat/tubercul.html or in Atlanta, visit the Treatment Resource Center at the AIDS Survival Project offices.