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'Every TB-HIV case is a public-health failure...'

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Shobha Shukla, Citizen News Service (CNS)

So said Helen Ayles. She was quoted by Dr Diane Havlir, who was speaking in the plenary of the 20th International AIDS Conference (AIDS 2014) in Melbourne, Australia. Dr Diane Havlir, who is a researcher at the University of California, San Francisco, was hopeful that "Every HIV/TB case prevented and every death averted should become a public-health success and put us one step closer to ending the dual epidemic of HIV and TB."

Agreeing that policy advocacy and implementation during the last 10 years has seen a 40% decline in TB-related HIV deaths and saved over 1.3 million lives, Dr Havlir rued that despite evidence-based prevention for HIV-TB co-infection, despite new state-of-the-art TB diagnostics, and despite the ability to cure TB and to reduce mortality with antiretroviral therapy (ART), there are still over 1 million new TB cases in people living with HIV (PLHIV) and 320,000 TB related deaths in people living with HIV (PLHIV) every year.

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She said that, "To step up we need to understand who is dying and why they are dying; adapt evidence-based care-delivery systems that are patient-centric; pay more attention to most at-risk populations (MARPs) for HIV/TB; and invest in research to improve prevention, diagnosis, and treatment."

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India stands 3rd among the top 10 countries with highest TB-related deaths in PLHIV every year (42,000). All the other countries are in Africa, with South Africa topping the chart with 88,000 such deaths every year. The main reason for this high mortality is obviously not diagnosing and treating people early enough. So, the mantra is-- Diagnose and treat TB and diagnose and treat HIV.

Preventing TB in PLHIV

A combination prevention treatment of ART and isoniazid preventive therapy (IPT) can result in substantial reduction of TB in PLHIV. Studies have shown that early start of ART in PLHIV results in 65% reduction in TB cases and providing ART and IPT gives an additional 35% reduction in TB in high TB transmission areas.

TB in HIV+ children

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Dr Havlir agreed that children could not be left behind while we step up the pace to arrest the march of TB and HIV/AIDS. Childhood TB infection is relevant to all HIV/TB and TB control as much of the global TB reservoir is established in childhood itself. According to latest WHO estimates, over 650,000 children are infected with TB every year and around 75,000 deaths from TB occur in HIV-negative children.

Dr Mario Raviglione, Director of the World Health Organization (WHO) Global Tuberculosis Programme, had earlier told Citizen News Service (CNS) that, "In the absence of any data, TB-related deaths in HIV-positive children cannot be estimated. But given that HIV-positive children are more vulnerable to TB, these deaths could be in the range of 100,000 deaths every year."

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