HIV/AIDS-TB Co-Infection: What Prevalence Indicates?

Co-infection of TB (tuberculosis) has been a major concern in HIV/AIDS patients. TB remains an important public health problem and has been exacerbated by the HIV epidemic, resulting in increased morbidity and mortality wordwide. HIV-TB co-infection is “bidirectional and synergistic” and is often designated as “Cursed Duet” (1) HIV/AIDS leads to immunosupression and is a strongest of all known risk factors for the development of TB. Indeed, after decades of consistent decline in incidence, a resurgence of TB is occurring globally. 9% of new TB infections worldwide are attributable to HIV, in region with higher HIV prevalence—about 31% of new TB cases are attributable to HIV(1).HIV/AIDS increases the risk of progressive disease following primary TB, leads to reactivation of latent bacilli and can also increase the risk of TB from exogenous infection. The course of HIV infection is accelerated subsequent to the development of TB. Risk of death and development of other opportunistic infections is higher in HIV-TB co infected patients. Even increase in replication of HIV has been demonstrated locally in such patients. Drug interaction incidence is also high. More than that, direct &indirect cost of illness can have catastrophic impact (1). Unlike other opportunistic infections which occur at CD4+ count below 200/mm3, active TB occurs throughout the course of HIV disease. Extra-pulmonary tubercular manifestations occurs in 46 to 79 per cent of patients with pulmonary TB and HIV co-infection and is more frequent in severely immunocompromised patients. Disseminated form is also seen frequently. HIV/AIDS can effect natural course of disease and pose diagnostic difficulties and may effect negatively the treatment due to frequent drug interactions in advanced state of disease. Hence, it is important to identify them early to reduce the morbidity, delay mortality and improve quality of life in HIV/AIDS patients.