TB/HIV at the International AIDS Society conference 2018 in Amsterdam
Posted by Maria Codina on July 31, 2018 at 9:30 am
Report back from KNCV
TB and hepatitis were frequently mentioned in sessions dealing with co-morbidity/mortality of PLHIV and in treatment and care sessions. In summary:
- TB/HIV prevention and care has shown much improvement in terms of policy and practice over the past years, but systematic quality screening for TB among PLHIV, TB preventive treatment and TB infection and prevention are often poorly implemented and need to be strengthened to reduce mortality and morbidity from TB among PLHIV.
- TB disease is the most frequent cause of death among PLHIV and is often not diagnosed, as is clear from various autopsy studies among PLHIV.
- In order to combat this there was a clear call for better coordination between HIV and TB programs and for the provision of integrated, one-stop-shop patient-centered care for PLHIV and people with TB disease living in high prevalence countries and for specific populations at risk.
- Immediate provision of ART to PLHIV clearly strongly reduces the incidence of TB disease among PLHIV, but it is even much more effective if combined with TB preventive treatment. Several new TB preventive treatment regimens are now available and promoted by WHO, which include a combination of rifapentine or rifampicin with isoniazide. The duration is much shorter than the 6 or 9 months of isoniazide daily tablets: one month (rifapentine/isoniazide daily), three months (rifapentine/isoniazide once per week 12 doses), three-four months (rifampicine/isoniazide daily. These shorter regimens may be more attractive for the persons who receive them, thus resulting in a better adherence and higher treatment completion.
- HIV and TB care for prisoners (e.g Brazil and Russia) showed that prisoners in general have poor access to TB and HIV prevention and care. Prisons often act as incubators for both TB and HIV because of poor living conditions (crowding and lack of ventilation facilitating TB transmission) , unprotected sex (consensual or coerced), and sharing of needles among drug users.
- Persons Using Drugs (PUDs) are at increased risk for TB, HIV, and hepatitis in particular when they inject drugs. The criminalization of use of drugs clearly has a very negative impact on HIV and hepatitis transmission as well as TB because of the associated lack of harm reduction programmes (needle and syringe programs, Opiate Substitution Therapy and Nalaxone) and TB-HIV care (screening, diagnosis and treatment) for such persons.
- HIV programs are promoting the use of laboratory testing for Early Infant Diagnosis (EID) and Viral Load Testing using the GeneXpert test platform, which is also scaled-up and used by TB programs for testing of TB and rifampicin-resistance. The TB LAM test is a rapid point-of-care dip-stick test for diagnosing TB disease in urine of PLHIV with very low CD4 counts. Although it is available on the market for a price comparable to a rapid HIV test, it is not being utilized very much. This is considered a lost opportunity for diagnosing TB disease quickly – particularly among PLHIV in a very poor clinical condition who are usually admitted in hospital.
- The need of both HIV and TB programs for well-equipped and operational lab services and laboratory sample transportation systems calls for good collaboration and coordination between the programs on laboratory systems strengthening, ensuring reliable quality assured services for PLHIV and persons with TB
In short, good progress on TB/HIV management and care globally, but still with many challenges to be addressed to reduce morbidity and mortality of PLHIV with TB infection and dis