Health watchdogs sound alarm over TB/HIV deaths

JULY 22, 2010 12:02 PM

BY RICHARD INGHAM, AGENCE FRANCE-PRESSE

Demonstrators march in Vienna's streets on July 20, 2010 as part of the 18th International AIDS Conference.

Photograph by: Samuel Kubani, AFP/Getty Images

VIENNA - Two global health agencies joined forces on Thursday in a campaign aimed at averting 200,000 deaths each year by co-infection from tuberculosis and the AIDS virus.

"Every three minutes a person living with HIV has his or her life cut off prematurely by TB," said Jorge Sampaio, UN Secretary General Ban Ki-moon's special envoy on stopping tuberculosis.

"This is completely unacceptable. TB is a preventable and curable disease."

Sampaio presided over a signing of a memorandum of understanding on the sidelines of the 18th International AIDS Conference, gathering the UN agency UNAIDS and Stop TB, a public-private health partnership.

They pledged to work towards halving the mortality from TB/HIV in 2015 compared to a base line of 2004, a year in which 400,000 people died.

"We are talking about a massive human tragedy," the executive secretary of Stop TB, Marcos Espinal, told AFP. "African countries in particular have been devastated by co-infection."

Espinal estimated that several billion dollars each year would be needed to reach the 2015 objective, but much of this could come from smarter use of existing resources.

"There is a package of activities that if properly implemented by countries will work," he said.

Several dozen activists demonstrated before the event, pounding drums and holding up a black coffin symbolising the death toll from co-infection by the two microbes.

In the middle of the past decade, researchers uncovered the dismaying consequence from these two overlapping pandemics: people who were co-infected were often placed on the fast track to death.

TB is a lung disease that is caused by a germ, Mycobacterium tuberculosis. Around two billion people around the world are infected by the bacteria, but the vast majority never fall sick. A far smaller number — nine million a year — develop symptoms of the disease.

However, the risk doubles when an individual is infected by HIV, which weakens the immune system, allowing the germ to run riot.

Without TB treatment, which costs around 25 dollars a person, 90 per cent of co-infected people die within two or three months. Of the two million deaths that occur from HIV infection each year, around one in four is linked to TB.

Alasdair Reid, HIV/TB adviser at UNAIDS, said co-infections could to a large degree be tackled through simple measures and under existing guidelines.

Investment in health clinics and labs should focus on facilities that can diagnose and treat both infections at the same time. Careworkers should be trained to ask a patient with HIV whether he has been coughing recently, to see whether antibiotics should be initiated.

Separately, French and U.S. researchers reported good results from a Cambodian trial into boosting survival chances for people who were badly infected with HIV and newly diagnosed with TB.

The standard approach is to begin TB treatment and then wait eight weeks before administering antiretrovirals, which repress HIV.

The reason for the delay is a condition called immune reconstitution inflammatory syndrome, in which the immune system essentially goes haywire and makes the infection far worse, sometimes lethally.

But the survival chances are better if the antiretrovirals are started only two weeks after beginning the TB treatment, the study found.

Researchers enrolled 661 adult volunteers at five sites in Cambodia.

Fifty-nine out of 332 patients who started antiretrovirals two weeks after beginning TB treatment died, compared to 90 out of 329 counterparts who started anti-HIV drugs after eight weeks.