HIV 8 – Tuberculosis (TB)

The earliest historical references to TB in Egypt are in a medical papyrus dated to 1550 BC.^3a
Although TB was present in Europe in the middle Ages, it was in the 1600s that the disease reached epidemic proportions.^3b By the mid seventeenth century, one in every five deaths in the city of London, was due to TB. From then until the 1800s, it was called the White Plague of Europe.^3b

Because HIV weakens the immune system, when that person becomes infected with TB, their body cannot fight off the bacteria and they become sick soon after they have become infected therefore resulting in the presentation of Active TB.^4c

• Without treatment, TB is potentially life-threatening.^2d
• TB is the leading cause of death among people living with HIV.^2e,5a
• Active TB accelerates HIV disease progression.^6a
• Antiretroviral therapy (treatment for HIV) restores the immune system thereby reducing the risk of developing TB.^5a
• TB is preventable and curable if treated early on.^4e,g

Free testing for TB can be done at your nearest clinic. Testing for children is done using skin tests and chest X-rays. Testing for adults is done by taking two sputum (this is not saliva) samples and the results are normally available after 2 – 3 days.^7a

It is important to note that treatment will only be successful if the drugs are taken EXACTLY as required for the entire duration, which is usually a 6 month period.^4e
The risk for other opportunistic infections is higher in HIV/TB-co-infected persons than in HIV positive persons without TB.^6b

Anti-TB drugs improves survival and quality of life for people with TB and also reduces the chance of spread of infection.^6c A combination of drugs are used to treat TB infection.^4e
Rifampicin (RIF), Pyrazinamide (PZA), Isoniazid (INH) and Ethambutol (EMB) are the most frequently used anti-TB drugs used to treat TB infection.^1b,2f  Streptomycin (injected into the muscle) is sometimes also used as first line treatment.

Vitamin B6, also called pyridoxine, is used to prevent isoniazid-associated side-effects.^1b
Cotrimoxazole is a combination of two antimicrobial drugs used to prevent additional infections that might occur if a patient has HIV and TB.^1b
Fortunately, companies are continually researching ways to improve TB therapy and one way that can be done is to improve the way in which tablets are taken. There is now a convenient 3-in-1 tablet that incorporates INH, B6 and Cotrimoxazole in one tablet taken once-a-day.^1c  This tablet is used in the prevention of opportunistic infections, and not as TB treatment in HIV positive patients.^1c

Unfortunately, there is some measure of drug resistance to some TB drugs. This means that in some people, the usual drugs do not work. This is called drug resistant TB, and a person may have to take different combinations of medicines to target the resistant bacteria.^4f

There are important drug interactions that can occur when both HIV and TB treatment are given together.^8a

TB can be prevented by stopping the spread of bacteria from one person to another.^4g