Tuberculosis and AIDS: an alarming combination

Tuberculosis, one of the oldest known infectious diseases, isnow the leading cause of death for people with AIDS, causingconcern that the deadly combination could become a health crisis inboth the United States and abroad.

Avoiding combined infections of HIV/AIDS and TB is a two-foldtask. First, the public must be educated in prevention. Second, thediseases must be identified early and properly treated.

To make matters worse, the appearance of drug-resistant strainshas made treatment of TB more complex, more expensive and lengthierthan it used to be. However, even the drug-resistant strains of TBcan almost always be cured, provided the disease hasn’t progressedtoo far before detection.

HIV/AIDS fastfacts:

As of January, 2002, in the UnitedStates:
• 40,000 people are newly infected each year.
•90% do not know they are infected with HIV.
•Half of those infected are under the age of 25.
•Every hour a teenager is infected with HIV.
•1 in 300 teens are HIV positive.
•African Americans and Hispanics account for 58% of adolescentmales with AIDS and 83% of adolescent females with AIDS.

As of January, 2002, in Oregon
• There were an estimated 8,354-13,154 people living withHIV.
•As of 10/31/99, there were 4,554 AIDS cases.
•There were 2,636 deaths due to AIDS.

Preventing HIV/AIDSinfection:

Prevention of HIV/AIDS is largely a matter of avoiding sexualbehaviors that expose a non-infected person to the blood, semen orvaginal secretions of an HIV-infected person.

Do not have sexual contact with anyone unless you know they arefree of HIV infection.

Use a new latex condom each and every time you have a sexualcontact.

If you inject drugs, seek treatment for your addiction. Use a cleanneedle each time you inject and do not share needles.

HIV-infected women need special management to avoid transmittingHIV to their infants during pregnancy and delivery.

Infants should not be given breast milk from an HIV-infectedwoman.

“The problem is with the people who are infected and don’t knowit,” Portland Internist Alar Mirka said. “Not only do these peoplenot receive the treatment they need, but they also continue toinfect others.”

Tuberculosis is spread by airborne bacteria that enters the bodythrough the lungs. Many people who are infected do not becomeovertly ill but carry dormant TB bacilli in their bodies.Tuberculosis finds AIDS patients an especially easy target, eitherstarting up new infection or reactivating dormant bacilli.

As more persons are infected with TB, an increasing “load” of TBbacilli enters the community, further increasing the numbers ofpeople at risk for contracting the disease.

In Multnomah County, reported cases of TB have been above thestate average for the last five years, with a disproportionateimpact on people over age 35 and people of color. Here in theUnited States, tuberculosis and HIV/AIDS are so often seen togetherthat the Center for Disease Control now recommends AIDS screeningfor all people newly-diagnosed with TB.

The AIDS-tuberculosis crisis is also a worldwide problem.According to the National Institutes of Health, one-third of theworld’s population carries the TB bacillus and five to ten percentof those carriers will develop active infection in their lifetime.Worldwide, TB kills 2 million people each year. When those numbersare extrapolated, the spread of HIV/AIDS appears to fuel a globalTB crisis that could infect one billion people in the next 20years.

Over the past decade, the twin specters of the humanimmunodeficiency virus (HIV) and acquired immune deficiencysyndrome (AIDS) have seemed to fade from the collective radarscreen. Yet people continue to acquire and die from HIV/AIDS.

Despite improved treatment and a reduction in HIV/AIDS infectionrates by as much as 50 percent over the past decade, in 2002, 428Multnomah county residents were newly diagnosed with HIV infection,while 142 were diagnosed with full-blown AIDS.

Treatment of HIV/AIDS today is aimed at reducing the body’sviral load, supporting the immune system and avoiding infection.”AIDS has become a chronic disease. People learn to live with itand most can live out a normal lifespan,” Mirka said.

While AIDS cannot be cured, it can be managed with a “cocktail”of medications and anti-viral drugs may help prevent HIV infectionfrom ever becoming full-blown AIDS. Thanks to priority funding ofHIV/AIDS research by the National Institutes of Health, newtreatments continue to become available.