Tb In India Essay

5137 words - 21 pages

TB in IndiaIntroductionThe increasing rate of human immunodefi ciency virus (HIV) infection in many countries has had an impact on tuberculosis (TB) epidemiology. While TB prevalence has remained stable, TB incidence continues to rise, especially in countries most severely affected by the HIV epidemic as well as those facing political turmoil, migration, poverty and unemployment and where intravenous drug abuse is rampant. HIV is the most important known risk factor that promotes progression to active TB in people with Mycobacterium tuberculosis infection (TB/HIV A Clinical Manual 2004). The lifetime risk of tuberculosis in immunocompetent persons is 5% to 10%, but in HIV positive individuals, there is a 5% to 15% annual risk of developing active TB disease (Swaminathan et al 2000). WHO estimated 9.2 million new cases of TB globally in 2006 (139 per 100,000); of whom 7,09,000 (7.7%) were HIV positive (World Health Organization 2008). India, China, Indonesia, South Africa and Nigeria rank fi rst to fi fth in terms of incident TB cases. In India, there were 2.5 million people living with HIV and AIDS (PLWHA) at the end of 2007 while the incidence of TB was approximately 1.8 million cases per year (WHO Release 2007, RNTCP 2008). In a survey carried out among new tuberculosis patients by the Revised National TB control Program (RNTCP) in 2007, HIV sero-prevalence varied widely and ranged from 1% to 13.8% across the 15 districts (Central TB Division, unpublished observations). Currently, it is not clear what role the HIV epidemic has played in the TB situation in India. If HIV prevalence in the community continues to increase, however, it could affect the TB control program, by decreasing cure rates and increasing mortality and recurrent TB. Further, appropriate management of patients with TB/HIV requires not only treating the tuberculosis but referring them for CD4 count testing and anti-retroviral treatment, if indicated.2. Impact of HIV on TB manifestationsHIV infection is associated not only with an increased incidence of TB, but with altered clinical manifestations especially in the advanced stages. As HIV progresses, there is cutaneous anergy as well as impaired tissue containment of mycobacteria leading to widespread dissemination of mycobacteria. Figure 1 shows the increasing risk of tuberculosis as CD4 declines. In patients with latent TB infection, the risk of developing active disease is higher among recently infected persons compared to those with chronic infection but is several hundred-fold higher among persons who acquire HIV (fi gure 2). Further, among persons with HIV infection, newly acquired TB infection can rapidly progress to active disease. It is clear that HIV infection acquired after TB infection is a signifi cant risk factor for development of active TB- - mainly due to its effects on the immune system. HIV is associated with decreased chemotaxis, defective granuloma formation and maintenance, impaired antigen processing and...

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