Chair: Simon Collins, HIV i-base
Speaker: Susan Cole, UKC
Rapporteur: Gary Burns, NLTSG
This workshop was attended by 12 people and was for anyone interested in TB treatment and care.
Susan started her presentation with some background information about TB. It is becoming more common in the UK and in 2002 there were 7000 cases. TB kills 3 million people worldwide each year, yet in 98% of cases where treatment is available TB is a curable disease.
TB and HIV infections are very closely linked and in countries where rates of one disease are high, high rates of the other soon follow and co-infection with both illnesses is very common.
People living with HIV who are working in the HIV field, volunteering or attending support groups need to know how infectious TB is and whether they may be at risk when mixing with potential carriers. Infection risk is based on whether someone has active or latent infection – with only active infection being infectious.
Casual contact is unlikely to result in contracting TB from someone with active infection, but spending time in enclosed spaces increases this risk. Coughing or sneezing into a handkerchief prevents the micro-organisms from being ‘aerosolised’ and reduces the risk of spreading the infection through air. This is why TB tends to spread among family members and those sharing accommodation.
TB is responsible for 44% of AIDS diagnoses in heterosexuals. 50% of those co-infected with TB find out that they are HIV+ when diagnosed with TB. Specialist help should be sought in treating TB. Although the cure rate is 98% and requires continuous treatment for a total of six months, treatment is more complicated and more difficult in HIV-positive people.
The lifetime risk for latent infection reactivating in an HIV-negative person is about 10%. The risk for reactivating in an HIV-positive person is about 10% per year.
One important consideration is that the drugs used to treat TB affect the drugs used to treat HIV and this will have implications for treatment of both diseases. This is more complicated in people with low CD4 counts (especially when <100) when both treatments are needed at the same time. With higher CD4 counts it is usually recommended to delay HIV treatment until after the first 2 months of intensive 4-drug TB treatment. If the CD4 count is over 200, then HIV treatment can be delayed further still, until after the secondary phase of 4-5 months dual-drug TB treatment.
This is why treatment of HIV/TB co-infection requires expert care from a specialist with both areas of expertise. Immune reconstitution syndrome is a serious risk in advance HIV disease. Referrals or dual care in the UK is recommended with Dr Anton Pozniak, based at the Chelsea and Westminster hospital, is one of the main experts in the field of TB and HIV co-infection.
There are draft BHIVA guidelines on treatment (see www.bhiva.org), as BHIVA is currently reviewing its recommended best practice.
Casual contact is unlikely to result in contracting TB
TB is a curable disease in 98% of cases (where treatment is available)
Most effective TB regimens include Rifampicin but this drug has serious interactions with NNRTIs and Protease Inhibitors
Treatment should be by a specialist in TB/HIV co-infection, especially when CD4 count is <200
Immune reconstitution syndrome is a serious risk in advanced HIV disease
For full details see BHIVA guidelines for co-infection
HIV service providers should provide staff, volunteers and service-users with information about the risks of contracting TB
TB and HIV specialists should work together to ensure the appropriate treatment for both illnesses
Earlier HIV testing in high risk groups will improve the prognosis of both illnesses
This workshop was evaluated by 12 people between the ages of 27 and 47 (average age 39).
Gender
4 female, 7 male, 1 not stated
Ethnicity
5 white, 4 black African, 3 not stated
Sexuality
4 heterosexual, 4 gay, 4 not stated
Usefulness
Very useful |
Useful |
Not useful |
83%(10) |
17% (2) |
0% (0) |
NOBODY said not useful
5 people set action points
Develop further understanding of TB and HIV
Take precaution and tests
Add on to the literature I'm writing up
Advise others on how to get help
General awareness - new information
Move on to Telling People