The TB burden in a community dropped as the uptake of antiretroviral treatment increased said Dr Francesca Conradie last night, referring to research by Karen Middelkoop from UCT.
Conradie, the clinical adviser to Sizwe Hospital, was reviewing the challenges of treating TB at the HIV Clinicians Society of Southern Africa meeting in Johannesburg.
One in 10 South Africans – rising to 2 in 10 in the Western Cape – would be infected by TB in their lifetime, she said at the start of her talk.
Conradie said if something looks like a duck, walks like a duck and quacks like a duck, it is probably was a duck. Ditto TB: clinicians usually knew what the symptoms looked like and should act on this promptly since delays killed patients with HIV.
Clinicians president Dr Francois Venter reported that 75% of patients in a new autopsy study at Johannesburg Hospital had TB.
“No HIV-infected person should die without the treatment of TB considered,” Conradie said.
She suggested that patients with AIDS and TB should started TB treatment and about a week later initiate ARVs, with the clinicians being prepared for IRIS.
IRIS – HIV-tuberculosis immune reconstitution inflammatory syndrome – is seldom fatal and could be treated though complications ,she said.
Conradie said, on average it takes 99 days for a confirmed TB diagnosis of an unemployed male patient.
She said that traditional healers were slightly faster than tertiary hospitals in picking up TB – GPs taking on average 10.5 days, traditional healers 21 days and tertiary hospitals 30 days. But these hospitals often had extremely complicated cases to treat, Conradie said in their defence.
Conradie reviewed the outdated microscopy and old TB drug in use. She reported, however, that three new drugs have been developed for drug-sensitive TB and that powerful drugs (like TMC207) were being tested for resistant strains and showing promising results.
Isoniazid Prevention Therapy (IPT) for all HIV-positive people should be started carefully and monitored carefully, she said, warning that drug resistance does develop.
TAC has been campaigning for IPT, on the ground that it reduces the risk of TB by just under 70% for people with HIV.
TB prevention studies were on the agenda at CROI 2010, which Conradie just attended.
Conradie recommended finding TB patients, particularly those with MDR-TB, more quickly and possibly treating them at home if they met certain criteria (eg stable accommodation).
By law in South Africa the state cannot constrain TB patients.