"The leading cause of death for people living with HIV is inaccessible diagnostics" rightly said Loon.
"Most of us have forgotten what AIDS looks like (as people with HIV who are receiving treatment and are virally suppressed remain healthy fulfilling lives. No one should develop AIDS or die of AIDS). Many countries hardly do CD4 tests anymore and manufacturers have stopped making the tests because they say they are not profitable enough. Without CD4 tests how will we manage advanced HIV disease?" asks Loon.
"The people who are developing advanced HIV disease (or AHD), have not been able to access treatment and do not have the opportunity to achieve undetectable equals untransmittable (or #UequalsU). Some of them have TB, or drug-resistant forms of TB and some develop cryptococcal meningitis," he added. U equals U refers to the WHO backed evidence that there is zero risk of HIV transmission from people with HIV whose viral load remains undetectable. So, undetectable equals untransmittable and HIV treatment is prevention.
"Most experts will tell you the leading cause of death for people with advanced HIV disease is TB. They are wrong - the leading cause of death for people living with HIV is inaccessible diagnostics. We have developed very cheap, effective TB diagnostics, such as TB LAM that only cost about US$ 3, but in many countries including my own, we cannot access it," questions Loon.
Loon is right: it is 9 years now since WHO guidelines recommended TB LAM test as it has better sensitivity for diagnosing TB among people with HIV. Its sensitivity is even greater for those with lower CD4 counts. There should be no delay between the time when scientific breakthroughs happen (like TB LAM test) and by the time they reach the people and are deployed equitably to fully yield the public health gains. TB LAM point-of-care test is based on the detection of mycobacterial lipo-arabino-mannan (LAM) antigen in urine.
We have progressed but major gaps remain
In India, as per government's Sankalak report, in 2022, a little over 1.2 million viral load tests and 930,000 CD4 tests were done (when number of people on antiretroviral therapy was 1.68 million in 2022).
In India, TB screening for people living with HIV is done verbally for 4 classic symptoms of TB of the lungs. Even in general population, government's TB prevalence survey shows that over half of people with active TB disease were asymptomatic (and found only when x-ray screening was done and all those found with presumptive TB were offered a confirmatory TB test). So, why are we not finding TB with best of science and technology (such as artificial intelligence-backed ultraportable handheld x-rays that can be used by community health workers to screen people for TB) among those who are a heightened risk of TB (such as people with HIV)? Risk of extrapulmonary TB is also higher which will warrant stronger action to find all TB, treat all TB and prevent all TB among people with HIV.
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