Posted by By AZOMA CHIKWE on
People who have features of tuberculosis like loss of weight, chronic cough, night sweat or coughing and bringing out blood from the chest may have contracted the Human Immuno-deficiency Virus (HIV).
People who have features of tuberculosis like loss of weight, chronic cough, night sweat or coughing and bringing out blood from the chest may have contracted the Human Immuno-deficiency Virus (HIV).
Dr Suleiman Akanmu, Consultant haematologist and co-ordinator, HIV/AIDS Treatment Progreamme at the Lagos University Teaching Hospital (LUTH), Idi-Araba, stated that experts widely believed that majority of people today who present with symptoms of tuberculosis, have HIV infection as the underlying or pre-disposing factor or the cause of manifestation of tuberculosis.
According to a report, a woman who stopped kissing her husband as a preventive measure against tuberculosis because he was coughing, later got infected with HIV by the husband. Because unknown to both of them, HIV was the underlying factor for the cough. Both are currently on anti-retroviral treatment at LUTH.
Akammu disclosed that Harvard PEPFAR Programme is donating a DOT centre for the treatment of tuberculosis at LUTH. And why Harvard PEPFAR programme is actually donating that place is so that those people who will have tuberculosis in the environment who have not actually come forward for HIV testing, can be captured from the clinic.
Speaking on people who primarily present with tuberculosis and they are not sure if HIV is there or not? Akanmu explained, "Tuberculosis has been with us for a long time, HIV dated back to 1981, that was the first incidence of HIV in the United States of America, between 1981 and 2008 is about 27 years.
Whereas, tuberculosis is about a century old in the pages of textbooks. So, we told patients who have only features of tuberculosis, so in these people who have features of tuberculosis like loss of weight, chronic cough, or coughing and bringing out blood from the chest, or what we refer to as haemophysis. Because of our campaign and enlightenment about HIV/ AIDS, many of them are sent to clinic where they are screened individually for HIV.
"But in most rural centres and in many parts of the country, these patients will be presented to tuberculosis clinic and a number of them will never be screened for HIV. And this is why in all centres where our people are providing treatment for tuberculosis it becomes impertinent that we should set up HIV screening activities in those centres.
Because we know that a number of those people that is presenting with symptoms of tuberculosis, many of them have suffered depression of their immunity, that is why in fact, tuberculosis is rearing its head. So, we believe today that many people who will be presenting a symptoms of tuberculosis, many of them have suffered depression of their immunity, that is why infact, tuberculosis is rearing its head.
"So, we believe that majority of people today who will be presenting with symptoms of tuberculosis, a number of them will have HIV infection as the underlying or predisposing factor as the cause of manifestation to tuberculosis.
"In this hospital today, there is a check clinic in the department of medicine, where we refer patients who have tuberculosis primarily. In a tertiary hospital like this, we get patient referred to us, and patients that are referred to the chest clinic here, are patients that have real complications of tuberculosis. Not people who are just presenting for the first time.
The plan is to start what is called a DOT centre in LUTH, and this plan is at the advanced stage now. A building has just been donated to us, which has just been renovated, but the necessary tools are yet to be put there for us to start to operate a kind of health facility where people that have tuberculosis in the environment can attend and get what we refer to as primary care for tuberculosis.
"This DOT centre was donated by Harvard PEPFAR programme, and they have also agreed to equip it and put it to function. In fact, they are also developing a special laboratory for proper diagnosis of TB. The plan is at an advanced stage and very soon we will kick off. In fact, why Harvard PEPFAR programme is actually donating that place so that those people who will have tuberculosis in the environment who have not actually come forward for HIV testing, they can be captured actually from that clinic and that we are going to start very soon.
Continuing, he said: "The relationship between HIV and Tuberculosis is an unholy relationship or an unholy alliance. In the sense that the presence of one makes the other more severe. If an individual has TB disease and do not have HIV, it is much easier to cope with the TB disease. However, in the presence of HIV infection, it is very difficult, because the problem with HIV is that it destroys the body's immune system. And if the immunity is depressed, the individual is liable to develop a lot of opportunistic infections.
"What we refer to as opportunistic infection are infections that the body would ordinarily would have been able to ward off if the immunity were intact, but because of the presence of the deficiency state, caused by the presence of HIV, the body is unable to ward off these infectious diseases. And top in the list of infectious diseases that is a little bit prevalent in our communities is tuberculosis.
"Unfortunately, a large percentage of the population live with tuberculosis causing agent or tuberculosis organism. Because our environment is polluted heavily with tuberculosis organism, that is organism that is capable of causing TB disease. If immunodeficiency state is caused by HIV, the capacity that the body has in coping with tuberculosis organism is lost, an individual who ordinarily will not developed tuberculosis disease will now develop it.
"Now, if the immunity is depressed because of the presence of HIV and tuberculosis is rearing its ugly head, the problem is that the presence of TB helps to fuel the speed with which the HIV itself multiplies. And if the HIV multiplies at a faster rate, more destruction of the body immunity is done it becomes a vicious cycle. That is why we say it is an unholy alliance between Tuberculosis and HIV.
On how prevalent is the two diseases on the patients they are managing at LUTH, he said, "Honestly, until records prove otherwise, anybody with HIV infection must be screened for the presence of Tuberculosis diseases for a number of reasons. Why we must do that is because the TB is present in clinical stage in HIV disease. There are stages in HIV disease, we have clinical stage one, clinical stage two, clinical stage three and clinical stage four disease.
"If tuberculosis is present in the test for clinical stage three of HIV and have spread to other pars of the body like the lymph nodes, the liver, the bone marrow, the brain, it is what is referred to as extra-pulmonary tuberculosis and it exposes the individual more to clinical stage four of HIV disease. One reason you should screen an individual with HIV for TB is to determine whether the individual should be placed on antiretroviral treatment or not. But much more than that, if this individual that has HIV and TB needs to be put on antiretroviral treatment, you need to know the type of antiretroviral drugs that you must use.
"Because the most important drug that you use for the treatment of tuberculosis, Rifampicine, does not co-habit or interact very well with the drug that we use for the treatment of HIV. So, if it is present, there are some antiretroviral drugs that we cannot use. What we refer to protate inhibitor group of drugs cannot be used in the presence of TB, because you have to use Rivampicine as part of your regimen. And a number of what we refer to as nucleocide river stratate inhibitor cannot also be used in particular Nevirapine cannot be used.
"So, it is very, very paramount that if an individual is HIV infected, it is good to find out if TB is present or not. If TB is present it tells you what to do in the treatment of the patient and what choice of antiretroviral drug to use.
Akanmu explained further: "Well, I know that the Federal Government has malaria and tuberculosis programme, but the teaching hospital has not really bought into it seriously. Because, like I told you, this is a tertiary center, and the type of tuberculosis that are treated in our tertiary center are complicated types of tuberculosis. Tuberculosis that attacks the heart, that is tuberculosis Peri candiditis, or tuberculosis that has attacks the brain known as tuberculosis meningitis or tuberculosis that attacks the bones which we call Cox diseases and the patient is getting deformed.
"These are really complicated type of tuberculosis and there are tuberculosis referrd to us because this is a referral center. But because of the programme of HIV that is going on in the hospital and for the necessity of having to get more people into the HIV treatment programme, there is need to set up a DOT center that will be operating as a primary center, PEPFAR has refurbished on existing structure that can be used as a DOT center, but PEPFAR is not going to be supplying the drug for the place, PEPFAR is not going to give us the doctors we are going to use for the place, PEPFAR is not going to give us the nurses we are going to use for the place, but what PEPFAR have agreed to do is to equip the place, all the furniture, all the air onditioners, all the computers including a laboratory.
"PEPFAR itself is challenged to look for people who are HIV positive in our encironment and part of the way of looking out for them is not only by going out and asking people to do voluntary counseling testing, you can actually set up clinic where people can have DOT treatment and from there get as many people who are HIV infected. That is why they are putting money down to assist the hospitals in setting up a DOT programme.
"If we set up this programme, we are going to be collaborating with the Federal Fovernment of Nigeria. They are going to be supplying the drugs. And the Federal Government are going to be emplying all the doctors, all the nurses, they will all be on the pay-roll of the Federal Government of Nigeria. Federal Government has the staff, so they will pay the staff, Federal Government owns the structure which PEPFAR helpeds them to re-furnish.