Protecting HIV Patients From Tuberculosis

HIV patients at risk for secondary infections

(RxWiki News) People with HIV/AIDS are living longer lives now, but they still have compromised immune systems. Patients and their doctors need to be wary of secondary infections.

If a HIV patient is infected with another infectious disease, such as tuberculosis, it can complicate treatment and possibly cause death. This is a big concern in Sub-Saharan Africa, where 60 to 70 percent of patients with HIV are also infected with tuberculosis (TB). Dr. Jason Farley, a nurse practictioner at Johns Hopkins University who studies AIDS, is working to reduce the number of co-infections of HIV and TB in the region.

"Take precautions against secondary infections."

HIV is an autoimmune disease, weakening a patient's immune system and reducing their ability to fend off other diseases. TB is often found in the body as a latent, or inactive infection. Dr. Farley told dailyRX that HIV facilitates the transformation from a latent infection to an active infection.

Once TB is active, the patient can infect others. Their own body cannot fight off TB effectively, and it takes months of treatment to control. A growing problem is multidrug-resistant TB (MDR-TB), which accounts for 5 percent of all TB cases. MDR-TB is TB that does not respond to the two most common TB drugs, said Dr. Farley. It takes a minimum 24 months to treat a person with MDR-TB and HIV.

Drug-resistant forms of TB are extremely uncommon in the US, Dr. Farley said, as are coinfections with HIV. But it's another situation in South Africa. “The key thing that people point to is the overlap,” he said. TB already has a high prevelancy in the region, and it's considered the epicenter of the HIV/AIDS epidemic.

Dr. Farley is looking for a way to reduce the number of deaths and improve patient outcomes, without “the magic bullet” of a medication, as he calls it. When a patient must undergo 2 years of treatment, they have to navigate a lengthy and burdensome process. Unfortunately, there aren't enough doctors in South Africa to provide timely and effective diagnosis and care to each individual.

Dr. Farley believes that nurses can help. If a nurse practicioner is properly trained, he or she can prescribe therapy for patients, and take the burden off an overworked and overwhelmed physician. This method of treatment has had positive outcomes for other diseases, but it hasn't been proved in MDR-TB yet.

Dr. Farley is currently working on a study that will build on previous research, to understand if nurses can help reduce the crippling impact of MDR-TB on HIV patients. He says that if the method works, it will be beneficial to physicians, nurses, and patients alike.

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Review Date: 
November 4, 2011