TB and HIV Co-Infection Update: Global Becomes Local
Dr. Henry Fraimow, an infectious disease specialist and associate professor of medicine at University of Medicine and Dentistry of New Jersey (UMDNJ) Robert Wood Johnson Medical School, spoke to a group of health care professionals on 11 April 2013 in Baltimore, MD. Dr. Fraimow discussed TB and HIV infections and the affect these diseases have upon each other. His presentation included the global epidemiology of TB as well as current trends health care professionals are experiencing with TB in the US.According to Dr. Fraimow, there are specific management issues with these two infectious diseases and today there is an “evolving global catastrophe” arising from drug-resistant TB.
Key to understanding the relationship of these two diseases is knowing the difference between “latent TB” and “TB disease”. Dr. Fraimow explores the complexities of these TB diseases along with current treatment options. Most notable for health care professionals is the data provided on populations infected or most at-risk for TB, as well as the accepted standard of care for TB and HIV-infected patients.
Dr. Fraimow incorporates various clinical case studies throughout the presentation. They provide excellent teaching opportunities for the audience and serve as tools to gain valuable insight into the specific information to be extracted from patients that will best enable the health care provider to treat the patient. It is through one case study that he concludes: “HIV testing is part of the standard of care for management of all TB cases.”
For the first time in its history, the CDC recently published data showing the different parts of the world where TB and HIV-infected individuals are coming from. The demographics of TB are important to consider in determining who is at risk. Although TB cases in the US are on the decline, and had at one time “become a forgotten disease”, it is a disease that needs knowledgeable health care professionals. It is present all over the world and it will always be present in the US as long as populations are continuing to immigrate to the US. States with the highest immigration rates will continue to see new cases of TB among the lower socioeconomic classes.
“There is no perfect test for TB,” Dr. Fraimow warns. There are a variety of treatment options and each patient should be treated differently, depending on his or her specific risk factors. There are pros and cons to the various treatments and Dr. Fraimow summarizes the latest data available on the subject. He cautions health care professionals to be aware of physical as well as systemic symptoms of TB when making a diagnosis. No longer is delayed treatment advised, rather studies suggest that there is a “…significant mortality difference in people who are started early on antiretroviral therapy with TB compared to people for whom treatment is delayed.”
Joan Deoul, a retired attorney, is a free-lance writer based in Palm Beach Gardens, Florida