Since the beginning of the human immunodeficiency virus (HIV) epidemic, more than 60 million people have been infected globally and as on Dec 2006, nearly 39 million people were living with HIV/AIDS (PLHA) worldwide.

During the initial years, major focus of attention was on prevention activities, followed by “care and support” of infected individuals, particularly those suffering from opportunistic infections (OIs).

Over the past decade, there has been a tremendous increase in our understanding of molecular biology, viral structure and pathogenesis of the disease. This knowledge has led to development of number of new antiretroviral drugs and treatment strategies.

Though, antiretroviral therapy (ART) does not cure HIV/AIDS, but effective ARV regimens inhibit the efficient replication of the HIV, and reduce viral load to undetectable levels. This leads to slowing of disease progression and fewer opportunistic infections (OIs), and helps people lead more productive lives. This also led considerable reduction in stigma and discrimination due to HIV per se.

Successes achieved by ART in terms of delaying the onset of AIDS have transformed the common perception about HIV from being a “Virtual death sentence” to a “chronic manageable illness”.
 
TB should be part of the differential diagnosis in any HIV-infected person with unexplained constitutional symptoms.

The HIV/AIDS epidemic has increased the global tuberculosis (TB) burden, and has focused attention on the necessity to closely coordinate TB and HIV/AIDS control program services.

It is estimated that about 2.31 million adults are infected with HIV in India. Overall, HIV infected persons have approximately an 10 times greater risk of TB than persons without HIV infection.

This increased risk is detectable as early as HIV seroconversion, and the risk of TB almost doubles during the first year after HIV seroconversion.

The risk of TB in HIV infected persons continues to increase as HIV disease progresses and CD4 cell count decreases. While antiretroviral treatment can substantially decrease the risk of TB, this risk always remains higher than that in HIV negative individuals. Furthermore, among cured TB survivors with HIV infection, the risk of recurrent TB is also quite high.

In India 55to 60% of AIDS cases reported had TB, and TB is one of the leading causes of death in PLHA. HIV positive patients who have TB have higher mortality than HIV positive patients without TB.

Even if TB is successfully treated, TB may also accelerate HIV disease progression, increasing the risk of subsequent death or other opportunistic infections.

Consultant
Dr.Milind Kulkarni MBBS,TDD,HIV-Med