Tuberculosis often a symptom of underlying HIV infection<\/p>\n
By Chris Green<\/p>\n
JAKARTA (JP): There is no way to prove it at present, but it
\nappears that tuberculosis (TB) is the most common infection
\nassociated with AIDS in this country.<\/p>\n
However, it is probably not among the small proportion of
\ncases of HIV infection actually treated by doctors here, which
\namount to less than 2 percent of the total. The overwhelming
\nmajority of HIV cases in Indonesia, that staggering remaining 98
\npercent, are not treated -- or at least not treated as HIV.<\/p>\n
Infection with HIV, the virus that causes AIDS, leads to a
\nweakening of the body's immune system, which protects the body
\nagainst infection. Some 10 years after infection with HIV, the
\nimmune system becomes too weak to ward off infection.<\/p>\n
Tuberculosis (Indonesia ranks third, behind China and India,
\nfor TB cases worldwide) is one of the so-called opportunistic
\ninfections that take advantage of this weakness of the immune
\nsystem. When HIV-infected people fall sick and seek medical help,
\nthey are often diagnosed with a different condition, and this is
\nmost likely TB.<\/p>\n
The World Health Organization estimates there are 6,000 new
\ncases of TB every year in Indonesia attributable to HIV
\ninfection. This compares with less than a thousand cases of HIV
\nidentified in any year so far.<\/p>\n
Thus, the figure of 6,000 can be little more than an educated
\nguess; my guess is that the real number is higher. While only
\nabout 10 percent of the estimated number of new cases of TB in
\nIndonesia are diagnosed and treated, it is probably rare that
\ndoctors even consider that the cases they find may be connected
\nwith HIV.<\/p>\n
Because of their lifestyles, drug users are more vulnerable to
\ninfection with TB. And injecting drug users are at great risk of
\nHIV infection. We all know that injecting drug use, and the
\nsharing of needles, has exploded over the last few years in
\nIndonesia. We can assume the rates of infection of both HIV and
\nTB among this population are high. It is probable that as many as
\n100,000 -- or more -- injecting drug users in Indonesia are
\nalready infected with HIV. That's why I suspect that the figure
\nof 6,000 new cases of TB connected with HIV each year in
\nIndonesia is low.<\/p>\n
Doctors diagnosing cases of TB among their patients should
\nimmediately consider the possibility that this is connected with
\nHIV. They must discuss this with their patients to discover if
\nthey have been involved in behavior that may have put them at
\nrisk of HIV infection. This can occur mainly through sex
\n(heterosexual or homosexual) without a condom or sharing needles,
\neither while using illegal drugs or in a medical setting.<\/p>\n
If this is the case, they should counsel the patient to
\nconsider having a voluntary HIV test.<\/p>\n
Around the world, and probably also in Indonesia, TB is the
\nmost common cause of death among people with AIDS. TB is the only
\ncommon opportunistic infection associated with AIDS that is
\neasily spread to other members of the general population. But
\nlike other opportunistic infections, TB can be treated
\nsuccessfully.<\/p>\n
And there is no denying Indonesia has a TB problem.<\/p>\n
WHO estimated there were 591,000 new cases of TB infection in
\nIndonesia in 1998, the last year for which figures are available.
\nThis was an increase of one third over the previous year, and
\nmore than 140,000 died of the disease. But the WHO-supported
\nanti-TB program identified only a few of the new infectious
\ncases.<\/p>\n
Improving our response to TB, and understanding the connection
\nbetween HIV and TB, will help us to address both epidemics. World
\nTB Day on March 24, which commemorates the discovery of the
\ntuberculosis bacillus in 1888, provides an opportunity for us all
\nto advocate for these improvements.<\/p>\n
The writer is an AIDS activist in Indonesia and publishes
\nseveral newsletters in Indonesian on AIDS and drugs.<\/p>",
"url": "https:\/\/jawawa.id\/newsitem\/tuberculosis-often-a-symptom-of-underlying-hiv-infection-1447893297",
"image": ""
},
"sponsor": "Okusi Associates",
"sponsor_url": "https:\/\/okusiassociates.com"
}