|Regular screening for tuberculosis is an important component of the HIV/TB counteraction (interview)|
Tuberculosis as it is well known is one of the frequent associated with HIV infection diseases, as well as one of the main reasons of death of the people living with HIV.
HIV infection (HIV) and tuberculosis (TB), each disease separately, as well as combined HIV/TB infection are significant problems for many developing countries. Tajikistan is not an exception in this regard as well.
In order to get familiar with the taken measures in the country for the combined HIV/TB infection counteraction, we approached RUZIEV Murodali Mehmondustovich, Director of the Republican AIDS Preventive Centre of the Ministry of Health of the Republic of Tajikistan, Candidate of the Medical Sciences.
- Dear Murodali Mehmondustovich, how important is the issue of the combined HIV/TB infection for the public health system?
- The combined HIV/TB infection problem for the public health system is of great importance both in the world and in our country. Judge yourself, as a minimum, one third of the people living with HIV (PLWH) or HIV positive persons according to the World Health Organization (WHO) are infected by TB and probability that they (PLWH) will fall ill with the active form of TB over 20 times exceeds the similar index among HIV negative persons.
The combined HIV/TB infection (HIV/TB) is exceedingly dangerous for the people's life: according to the WHO's data, TB as a minimum is a reason of death of the people living with HIV in 25% of cases. According to the WHO's data in the world in 2011 active form of TB was revealed among 1.1 million people living with HIV, and 430 000 people died from TB associated with HIV.
- With regard to the abovementioned what measures are taken in the country for counteracting HIV/TB?
- The measures taken against HIV/TB in our country are of a complex nature and in particular comprise of early diagnostics or revealing TB among of people living with HIV, prevention of TB, etc. For the early diagnostics of TB all people living with HIV, who are under the dispensary observation of the AIDS centres specialists, regularly go through the screening (the method of the active revealing the persons with some diseases - Ed.) with use of the corresponding clinical algorithm. Screening is one of the important components in the system of counteraction the combined HIV/TB infection.
- What is that clinical algorithm used during the screening?
- A clinical algorithm is recommended by the WHO and comprises of a number of symptoms presence of which (one or several) at an HIV positive person (further patient) may be an indicator of the active TB: cough at the present time, increase of the body temperature, loss of the weight, perspiration at night. This concerns both the adult and teenager patients. In group of children living with HIV, the following symptoms should be taken into account during the screening: bad gain in weight, increase of the body temperature, cough at the present time and contact with TB patient in the child's disease history.
Screening is very important for maintaining the patients’ health. Under its positive result further a thorough examination of the patient is conducted for TB, which allows to implement the early diagnostics of this infection and conduct the anti-tuberculosis treatment, which in most of the cases can be efficient. As it is known the tuberculosis is a curable disease.
Screening must be conducted during each time the patient visits his physician and/or physician's assistant. Patients, in their turn need to immediately address physicians at appearance of one or other abovementioned symptoms. We urgently recommend patients’ relatives be aware of these symptoms and assist in patient’s early address for a medical help.
- What else is done according to the screening’s results?
- When active form of TB is excluded by results of the screening, patients are prescribed a preventive treatment with use of such anti-tuberculosis medication as Izoniazid.
Early prescription of antiretroviral treatment (ART), mechanism of which is aimed at suppression of the process of the HIV replication in human organism, plays an important role in prevention of TB as well as other opportunistic infections among HIV positive persons. This as a result increases the immunity of the patient and accordingly increases his resistance to TB. At present in accordance with WHO's recommendation, we begin ART at amount of CD4 lymphocytes≤350 cells/ml at patients.
Results from the WHO's systematic review of a number of the control studies show that beginning of the ART at amount of CD4 lymphocytes>350 cells/ml allows reducing the risk of development of TB among HIV positive persons in two times.
- In conclusion, how efficient are the measures of counteraction the combined HIV/TB infection in the country?
- Mentioning issue of counteracting the combined HIV/TB infection in our country I reiterate that this is a complex work, which is carried out in close co-operation among specialists from against HIV-infection and against tuberculosis specialized services of the Ministry of Health. This cooperation includes not only the screening and thorough examination of people living with HIV for TB, but also examination of TB patients for HIV and other measures. Employees of local HIV and TB service public organizations render their corresponding assistance in this work.
Annual increase in covering with the abovementioned examination of the representatives of both groups of patients (HIV, TB) in the country allowed revealing the combined HIV/TB infection in 116 cases only in 2012 or over two times against 2009. For the first six months in 2013 HIV/TB was revealed in 80 cases.
All people living with HIV, when the active form of TB has been revealed at them, as well as TB patients when HIV infection has been revealed at them go through treatment against tuberculosis in combination with ART. We begin ART in such cases (HIV/TB) irrespective of amount of CD4 lymphocytes.
Statistics of the last years shows the visible reduction of dynamics in death-rate in the group of patients with combined HIV/TB infection: over one and half times. Conservation of the people’s life is the most important in our work at estimation of efficiency of the complex approach in HIV/TB counteraction, which is used in our country.
Interviewed Numondzhon Abdukhamedov, Independent journalist
|Обновлено 09.10.2013 16:00|