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BMJ. 2007 March 31; 334(7595): 659.
PMCID: PMC1839172

Patients with tuberculosis in poor countries must be tested for HIV

A new report by Médecins Sans Frontières (MSF) says that all patients with tuberculosis (TB) in developing countries should be tested for HIV. And if patients test positive they should be given antiretroviral drugs.

Without antiretroviral drugs (ARVs), patients infected with both HIV and tuberculosis are likely to die from tuberculosis or other infections during or soon after treatment for their TB.

The report quotes a study in Thailand that found that “88% of co-infected patients who received ARVs were alive after 3 years of treatment—compared with just 9% of patients who, before ARVs were available, received only TB treatment.”

It is “vital that TB patients are tested for HIV and that they are put on effective treatment if found to be HIV-positive. Yet, shockingly, only 3% of co-infected patients in Africa are tested and found to be positive—and only 0.06% receive anti-retroviral treatment.”

“Diagnosing MDR-TB [multidrug resistant tuberculosis] is also extremely difficult. Most resource-poor settings do not have access to the necessary sophisticated equipment. But even in the best of settings that do, it can take up to eight weeks to get a result. In patients co-infected with HIV who are already sick, such delays can mean the difference between life and death.”

“In places where we see a lot of HIV/AIDS, the risk of MDR-TB spreading like wildfire is a terrifying, but all too likely prospect,” said Liesbet Ohler from MSF's Kenya programme. “With the tools we have today, we're fighting a losing battle.”

Tido von Schoen-Angerer, director of MSF's campaign for access to essential medicines, cautions, “MDR-TB, and now XDR-TB [extensively drug resistant tuberculosis] are the tip of an iceberg of failing strategies to curb TB. We desperately need new tools and we need them now—we cannot just sit and wait.”

The report claims that treatment will succeed in only about half of patients with multidrug resistant tuberculosis.

MSF says that insufficient research and development on new drugs and diagnostics has left health staff without the right tools to treat the disease “and thus some patients will go on to develop extensively drug-resistant (XDR) TB, regardless of the quality of care they are offered.” The situation is “particularly alarming” when treating people co-infected with tuberculosis and HIV.

“Effective TB treatment became available in developed countries 40 years ago and it is more than 10 years since effective AIDS treatment was introduced in the West. Yet the vast majority of those infected with these two diseases today live in the world's poorest countries and still die needlessly due to a failure of disease diagnosis and lack of access to the treatment.”

The charity maintains, “It is possible to treat people with these infections in the most difficult settings, through using innovative ways of finding, diagnosing, and treating patients. But we are hampered by the outdated and ineffective tools available for diagnosis and treatment and a lack of research.”The sooner people with HIV start tuberculosis treatment, “the greater chance they have of surviving.”

Notes

The report, Failure to Act, is available at www.msf.org.


Articles from The BMJ are provided here courtesy of BMJ Publishing Group