HIV AND Tuberculosis (TB)
South Africa has a high incidence of TB. This has increased dramatically as HIV incidence has grown.
- TB is one of the most common opportunistic infections for people living with HIV.
- TB progresses faster in people with HIV.
- TB is the leading cause of death in people living with HIV and AIDS in the country and in the world.
- People with TB are more likely to be infected with HIV and AIDS.
HIV-infected individuals have a higher rate of TB infection. This is because untreated HIV weakens the immune system, and a weakened immune system makes you more susceptible to TB. If people are ill with TB and not treated quickly, they can infect their friends and family, as well as other people in the community. In addition, untreated TB in individuals who are non-compliant to TB treatment can lead to multi-drug resistant (MDR) TB and/or extremely drug-resistant (XDR) TB.
How can I prevent becoming infected with TB?
- Cover your mouth when coughing or sneezing; this is called cough hygiene.
- Open windows to allow in fresh air, particularly in overcrowded areas.
- Educate yourself and your community about TB.
- Set up TB groups to assist with education, adherence to TB medication, testing for TB and giving people living with TB a place to share their problems.
- Train healthcare workers in prevention and how to protect themselves.
How can I prepare for TB treatment?
It is not easy to take TB medication. Duration of treatment is long and the medication has side effects that may make you want to stop treatment. Side-effects include:
- nausea
- hepatitis
- peripheral neuropathy (damage to the peripheral nervous system).
It is important to speak to your direct observation treatment (DOT) supporter or healthcare worker about the side effects that you experience. It is common for people to want to stop treatment once they start feeling better. You must complete your entire course of treatment, be it six or 24 months. If you do not complete your full course, you put yourself and others at risk.
Drug interactions
- Medication such as antiretrovirals (ARVs) may interact with the TB medication or produce more side effects.
- Avoid alcohol and recreational drugs. Taking alcohol with TB medication can cause hepatitis and liver failure, while recreational drugs make it difficult for you to stick to your TB treatment regime.
- Talk to your healthcare worker.
TB treatment
Preventative treatment
Latent TB is when you have a positive tuberculin skin test (TST), but no sign of active TB disease. TSTs are administered to detect the presence of mycobacterium tuberculosis, the bacterium that causes TB. You can be treated with a drug called isoniazid (INH) for six months. This is called prophylaxis. By taking prophylaxis, you are preventing the bacteria from having a chance to become active and making you ill. Do not take INH only if you have signs of active TB disease, as you may develop resistance to INH if used as a single drug in patients with active TB.
How do TB drugs work?
TB drugs are described as bactericidal or bacteriostatic. Bactericidal antibiotics kill bacteria, while bacteriostatic antibiotics slow the growth and reproduction of the bacteria. Some TB bacteria grow fast and are very active, while other TB bacteria take a long time to grow and reproduce.
What happens during treatment?
If you follow your treatment regimen, your symptoms will improve about two weeks after you start your treatment. After about three weeks, you are no longer infective or able to spread the disease to others. The four drugs you are taking will have killed lots of bacteria and made the rest unable to grow.
What is drug-resistant TB?
Drug-resistant TB means that some of the strongest TB drugs cannot fight the TB in your body because TB bacteria are learning to survive against the antibiotics. This is a big problem in South Africa. TB sufferers who do not adhere to their treatment regimen become drug-resistant. There is treatment for drug-resistant TB but it is costly, the course of treatment is longer and it also causes more side effects. Drug-resistant TB and regular TB have the same symptoms of cough, weight loss, night sweats and coughing up of blood.
Suspect multi-drug-resistant tuberculosis (MDR-TB) if you:
- have been in contact with someone who has MDR-TB
- have been treated with first-line treatment but did not complete it or take your treatment properly
- do not improve after two weeks of standard treatment
- are taking first-line treatment and do not become smear negative after two to three months.
It is important to speak to your healthcare worker if you suspect you may have drug-resistant TB!
Reference
1. METROPOLITAN FOUNDATION. 2009. B the Future cellbook. South Africa.