hiv_tb - HIV Tuberculosis co-infection problems and...

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1 HIV Tuberculosis co-infection problems and challenges Ajay Handa Dept of Pulmonary Medicine PGIMER •In t rodu c t ion • Magnitude of problem • Immunology of TB • Effect of co-infection • Clinical manifestations • Role of molecular diagnostics • Treatment guidelines Introduction • HIV pandemic has caused a resurgence of tuberculosis cases world wide after 1980s • The occurrence of co infection is major problem in developing countries • Risk factors for both infections are similar: poor socioeconomic class, homeless and IVDU Resurgence of TB Years 1982 1995 TB notification rate per lakh
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2 Distribution of TB 1990-99 Magnitude :HIV burden 0.15M 11% 1.35M Europe/USA 0.04M 23% 0.18M East Mediteran 0.4M 30% 1.3M Americas 2.4M 40% 6.0M SEA/W pacific 9M 48% 18.7M Africa Coinfection Prevalence of TB HIV inf WHO region Tuberculosis burden • 1.9 billion people infected each year • 8 million new cases each year • 2 million deaths each year(75% 15-50 yrs) • 95% cases and 98% deaths occur in developing nations • South east Asian region :India ,Indonesia, Thailand and Myanmar account for majority of cases of TB • Prevalence of drug resistance higher in this region Indian scenario • 40% of the Indian population has TB infection. • Every year, nearly 5 lakh die of TB – 1,000 deaths per day, one death every minute. • Each infectious patient can infect 10-15 individuals in a year unless effectively treated. • In India , TB kills 14 times more people than all tropical diseases combined, 21 times more than malaria,
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3 Indian scenario • After the first HIV positive case was detected in a commercial sex worker in Tamil Nadu in the year 1986 • Highest number of AIDS cases have been reported from Tamil Nadu, Maharashtra , Karnataka, Andhra Pradesh, Manipur and Nagaland. • Total no of HIV infection ~3.97 million • AIDS cases - 60 % had Tuberculosis HIV TB pandemic • TB is the leading opportunistic infection in HIV infected patients • Often the first indicator of immune deficiency (AIDS defining Illness) • World wide 40 million HIV infected of whom15 million are co infected with TB • Tuberculosis accelerates the progression of HIV infection and HIV increases the likelihood of active TB disease. Immune response to Tuberculosis • Two classes of CD4 T helper cells T helper 1 - produce IL2 and IFN gamma T helper 2 - produce IL 4,5,10 • Th 1 cells are major effector cell in the CMI (granulomatous response) and enhance clearing of infection by Tubercle bacilli • Th 2 cells impairs the granulomatous response to Tubercle bacilli and immunity Immune response to TB Mycobacteria alv macrophages phagocyotosis CD4 Th1 response bacteria killed within activated macrophages(granuloma) IFN gamma IL 2 IL 12 Primary infection 5% progressive primary 5% reactivation TB
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4 Immune response - HIV TB • HIV infection impairs the immune response • Progressive depletion & dysfunction of CD4 lymphocytes • Impaired macrophage function
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hiv_tb - HIV Tuberculosis co-infection problems and...

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