Tuberculosis and AIDS: Oil to the Flame

Little did she know that the symptoms she exhibited were those of tuberculosis (TB), as tests done on her proved later. TB is a highly contagious disease. Doctors at the hospital put Esther on a course of treatment that was to last several months.

"The treatment I was put on involved taking drugs daily for six months and thank God my husband and children always reminded me to take them without [forgetting]," she said. Esther was also diagnosed as being HIV-positive five years ago. Her situation was compounded by the fact that, just before embarking on TB treatment, she had started taking antiretroviral drugs (ARTs.) These are drugs taken to improve the immunity of people living with HIV/AIDS. "I was compelled to take many drugs each single day," she said.

High Infection Rates

Esther's case is not a single one.

According to figures released recently by the United Civil Society Coalition on HIV/AIDS, Tuberculosis and Malaria in Kenya, approximately 13 Kenyans die every hour due to TB. That adds up to 300 deaths daily.

The country is rated 10th among the 22 nations mostly affected by TB in the world. Most of these countries are in Southeast Asia and sub-Saharan Africa. In fact, it was no surprise when recently the British High Commission in Nairobi announced that Kenyans wishing to visit Britain for more than six months must be screened for TB.

The figure of TB-related deaths is fast closing in to the number of those who die as a result of HIV/AIDS-related complications, which stands at 400 people a day. There is growing fear that, if not checked, TB will overtake HIV/AIDS as the leading killer in sub-Saharan Africa.

The disease, which usually attacks the lungs, is caused by the bacterium Mycobacterium tuberculosis. However, experts say the disease can affect almost any part of the body. The bacteria normally enter the body through the lungs and stay there. TB is an airborne disease.

Like the common cold, it can spread through aerosolized droplets when infected people cough, sneeze, spit, or even speak.

Just a Cough Away

The World Health Organization (WHO,) states that TB patients may not feel ill, and at that period the infection is said to be at the silent or latent stage. When the infection enters the active stage, symptoms usually include coughing that lasts more than three weeks, loss of appetite and weight, night sweats, and bloody coughs.

"The disease is just a cough away. [That is] the reason why people living in poorly ventilated and crowded shelters are highly vulnerable," said Evelyn Kibuchi, TB Project Manager for the Kenya AIDS Non-Governmental Organizations Consortium, KANCO. Her views are echoed by Georgina Nyambura, a Nairobi-based community health care provider. She said that people living in the slums are highly vulnerable to TB infection, and hence require sensitization on sanitation and hygiene.

"When a person breathes in TB bacteria, it settles in the lungs. If the person's immunity is compromised, the bacteria multiply quickly,"said Kibuchi. "From the lungs, they move through the blood to other parts of the body, such as kidney, spine and brain. Unlike the lungs, TB in other parts of the body is usually not infectious."

Fortunately, she said the disease is treatable. Treatment involves the use of powerful antibiotics over a long period of time to fight the bacteria and ensure its dispersal. Early detection and treatment of the disease is important to minimize cases of infection to others.

A Deadly New Strain

However, Kibuchi raises concern over the emergence of drug-resistant TB. "When a strain of TB is resistant to two or more first line antibiotic drugs, it is called multi-drug resistant TB or MDR-TB. When it develops resistance to two or more second line antibiotics, it is classified as Extreme Drug Resistance TB or XDR-TB." She pointed out that people can catch MDR-TB and XDR-TB from others as well.

The TB project manager noted that poor drug adherence among TB patients receiving treatment is the major cause of drug resistance."This phenomenon occurs when TB patients fail to take medicine as prescribed and drug resistant mutations of the TB bacteria are allowed to replicate." She further said that drugs in use for TB treatment were developed over 40 years ago. As a result, they are not effective in treating resistant strains of the disease.

She reiterated that a new drug that offers a short treatment period needs to be developed to ensure patients adhere to the prescribed treatment.

Although Kenya has not recorded any cases of XDR-TB, there is fear that such cases could be present but undiscovered. This could be due to the lack of well-equipped laboratories to aid in the detection of XDR-TB cases.

XDR-TB has, however, been reported in South Africa. In early December 2006, the Health Department in the country reported that 263 cases had been recorded in the country's Kwazulu–Natal region, and 40 cases in other regions. The report also added that at least 74 people, including hospital staff, have died since January 2005 at a single hospital after catching the drug-resistant strain. Most of them were HIV-positive, and their immunity systems were already weak.

A Disease of the Poor

A fact sheet released this year by the WHO indicates that TB had infected two billion people worldwide so far. TB kills 5,000 of those infected every day. The report states that it is on the rise after 40 years of worldwide decline.

The increase has been recorded in poor countries, prompting TB to be labeled a disease of the poor. Most of those affected are young adults in their productive years.

Due to their weakened immunity systems, people living with HIV/AIDS are highly prone to TB infection. "The two diseases form a lethal combination, each speeding the other's progress," said Kibuchi whose organization, KANCO, is an umbrella organization for community and faith-based organizations in Kenya. KANCO carries out targeted advocacy activities throughout Kenya. These activities are aimed at addressing barriers to comprehensive TB treatment and control as well as offering care for the patients infected.

According to Kibuchi, 60 percent of people living with HIV/AIDS in Kenya are also infected with TB. "The situation has contributed to a lot of stigma being shown to TB patients, in the same vein as is shown to people living with HIV/AIDS," she said. A WHO report on TB and HIV co-infection states that many people in Third-World countries develop TB as the initial manifestation of AIDS. Kibuchi added that people who are HIV positive and infected with TB are also 50 times more likely to develop active TB in a given year than those who are HIV-negative.

This close connection has caused the two diseases to be referred to as "co-epidemic" or "dual epidemic" when describing their relationship.

It is frightening that TB, which progresses faster in HIV-positive people, is harder to diagnose when it infects them. Moreover, it is almost certainly fatal if left untreated. TB is able to take advantage of the weak immunity systems of HIV-infected people faster than many other opportunistic infections. Thus, people living with HIV/AIDS, like Esther Amolo, are at a higher risk of dying of TB.

Surprisingly, the WHO report notes that worldwide, TB causes more deaths among women than all causes of maternal mortality combined. More than 900 million women are infected with TB worldwide. The report states that in the year 2006 only, one million women are estimated to die of TB. Additionally, 2.5 million women, mainly aged between 15 and 44, will be infected with the disease.

The WHO findings attribute this scenario to the fact that all over the world, women bear a disproportionate burden of poverty, ill health, and malnutrition.

Tackling the Problem

The WHO advocates joint HIV/TB interventions to promote synergies between prevention and care activities for both diseases. The interventions, which are mutually reinforcing, can occur in homes, communities, and hospitals or clinics. They seek to prevent HIV and TB infections and to provide aid for people living with them. The WHO emphasizes human resources and infrastructure development, especially in HIV/AIDS high-prevalence countries, for these interventions to succeed.

These interventions are part of the internationally recommended five-component strategy to control TB, also known as Directly Observed Treatment, Short-course (DOTS). The components are as follows:

• Political commitment to sustained TB control
• Access to quality-assured TB sputum microscopy
• Standardized treatment, with supervision and patient support
• An uninterrupted supply of drugs
• Monitoring and evaluation system, and impact measurement

To augment the WHO strategies, the Global Partnership to Stop TB, a global movement to accelerate social and political action to stop the spread of TB around the world, was formed. It is currently involved in ensuring that TB patients have access to treatments and cures as well as protecting vulnerable populations from TB. It also endeavors to reduce the social and economic toll that TB exacts on families, communities, and nations.

Government Censured

During the 55th annual WHO Regional Committee Meeting for Africa, held in 2005 in the Mozambican capital, Maputo, 40 African health ministers declared TB a continental disaster. It was also agreed that individual nations would declare TB a national disaster. Unfortunately, in Kenya the government has been reluctant to declare the disease a national disaster. Experts have lamented that out of an estimated $33 million given to the country to fight HIV, malaria, and TB, only $5 million have been disbursed.

Addressing the press on World AIDS Day, Dr. Ignacius Kibe, a TB expert in a Nairobi-based health institution, said that there was a lot of bureaucracy in the disbursement of the funds. He also said that an HIV/AIDS bill recently drafted by the government ignored TB. The fact that it is a major killer of people living with HIV/AIDS was ignored.

Half of those in sub-Saharan Africa co-infected with AIDS and TB lack access to effective treatment. In Kenya, TB can be successfully treated at an affordable cost of $16. "It is disheartening when you look at the $16 that can buy drugs to save somebody with TB, and compare it with the vast sums invested so promisingly in the fight against AIDS, and which are likely to fail their impact when TB takes the life of somebody with AIDS," concluded Kibuchi of KANCO.

Sources:

The Kenya AIDS NGOs Consortium. www.kanco.org

Wanzala Bahati Justus is a freelance journalist based in Nairobi, Kenya. Your emails will be forwarded to him by contacting the editor at ScienceTech@islam-online.net.