Tuberculosis associated Human Immunodeficiency Virus, popularly known as HIV/TB co-infection, is affecting almost half of the patients (already living with HIV) in India, experts have told The Sunday Guardian. Tuberculosis is the most common, and the most serious opportunistic infection in patients, the risk of development of which is 26 to 31 times higher in the patients living with HIV.
Chief executive of HIV/AIDS alliance, Sonal Mehta, told this newspaper that in India, that in India, over 25% deaths related to HIV happen because the patient contracts active tuberculosis. Tuberculosis remains the leading cause of death among people living with HIV, accounting for around one in three HIV-related deaths globally, healthcare experts have noted.
Talking to The Sunday Guardian, Mehta recalled how one of her team members living with HIV contracted tuberculosis twice. The first time it was pulmonary tuberculosis, the second time, abdominal. During abdominal tuberculosis, doctors kept shunting the patient from place to place, telling her that since she was infected with HIV, she should only seek treatment for the same. She was routinely sent to general medicine doctors rather than specialists, till the time her condition worsened and she gave up hopes to survive. She then ensured that she was taken to a good doctor, who was then able to make a correct diagnosis and put her on right treatment. The patient, Mehta added, is now a survivor who educates people living with HIV on tuberculosis.
According to studies, in 2014, tuberculosis surpassed HIV as the world’s leading infectious disease killer. There were an estimated 1.4 million tuberculosis deaths in 2015, and an additional four lakh deaths resulting from tuberculosis among people living with HIV, including 40,000 children.
There is no official data on the magnitude of the HIV/TB co-infection in India, with only a few studies being conducted in tertiary health care centres. However, according to Dr V. Sam Prasad, country programme manager, AIDS Healthcare Foundation, global estimates point to over 11.7 lakh cases of co-infection that have been reported from across the world, out of which over 1.1 lakh cases are from India. However, according to Dr Prasad, it would be misleading to assume this data to be representative of the magnitude of the problem, which, he claims, is greater than what has been originally presented.
“Multiple reports and studies have said that India had 2.1 million cases of HIV (alone) in 2016. But these studies do not factor in the hidden, undetected infections. There are roughly 15 lakh patients who are seeking medical treatment for HIV/TB co-infection from private doctors/hospitals. These are the cases that are not even reported. We normally look at primary numbers and hence fail to correctly gauge the magnanimity of the problem,” Dr Sam Prasad said. He further pointed at the non uniformity in treatment prescribed by the private and public healthcare centres; there is an uncertainty whether the former follows the right regimen for detection and treatment as designed by the government under NACP (National AIDS Control Program) and RNTCP (Revised National Tuberculosis Control Program).
The patient’s immunity drops abysmally when he contracts HIV, and he becomes highly susceptible to tuberculosis. With the number of HIV cases being very high globally, it is dubious that India could have the number of HIV/TB co-infection at just 1.1 lakh, Dr Prasad noted.
The Centre has designed a joint HIV/TB framework under which all HIV testing as well as treatment centres refer patients for tuberculosis testing and treatment and vice-versa. This also includes an established coordination mechanism and a technical working group at national, state and district levels, joint training on HIV/TB for NACP (National AIDS Control Program) and RNTCP (Revised National Tuberculosis Control Program) staff, and case findings at HIV test centres. In addition, every treatment centre has a machine to ensure that testing of every case of HIV is done effectively for tuberculosis also.
Yet, a high rate of undiagnosed tuberculosis in people living with HIV remains prevalent. According to Sonal Mehta of HIV/AIDS alliance, late diagnosis or a poor tracking of people living with HIV and thereby, an eventual loss to follow up and reach out to people at a major risk, is problematic. As a reason, over 57% of HIV/TB cases remained untreated till 2015, multiple studies and experts have pointed out.