Preventable, treatable and curable diseases such as tuberculosis, pneumonia and thrush, for which there are often free or cheap drugs, are causing the deaths of hundreds of thousands of HIV-positive people, the United States based Treatment Action Group (TAG) has revealed.

Speaking at the Treatment Preparedness Summit recently held in Cape Town, TAG executive director Mark Harrington said that treatable and curable opportunistic infections were responsible for the deaths of most people infected with HIV/AIDS.

World Health Organisation research found that in Africa, only 2% of the more than six million people in need of two major prophylaxis drugs (drugs that can prevent a disease) are receiving it.

The two drugs, cotrimoxazole and INH, are used in the prevention and treatment of pneumonia and diarrhoea and the prevention of TB, respectively. Overall, only 10% of the estimated 6,5 million people worldwide who need these life-saving drugs have access.

Cotrimoxazole (Bactrim) prevents or treats pneumocystis carinii pneumonia, bacterial pneumonia, diarrhoea and toxoplasmosis.

Isoniazid (INH) prevents tuberculosis while fluconazole (Diflucan) is used in the prevention and treatment of cryptococcal meningitis, candidiasis (thrush) and other fungal diseases.

Head of the HIV/AIDS directorate in the national health department, Dr Nono Simelela told parliament’€™s health committee this week that significant resources were being spent on the three drugs.

She said INH was being dispensed in those districts with a high incidence of HIV coupled with TB.

‘€œThe challenge is to ensure that the supply is constant and uninterrupted,’€ Simelela said.

Harrington said that a survey done at a South African gold mine found that of the 599 hospital admissions among a group of HIV positive miners, 21% had TB, 18% had pneumonia, 6% had cryptococcal meningitis and 18% had other infections.

‘€œAll these infections can be prevented by opportunistic infection prophylaxis,’€ Harrington pointed out.

Of the mineworkers admitted, 82 died. Most of them had died of cryptococcal meningitis while the rest had died of TB and pneumonia. All these diseases could have been treated and often cured.

Harrington said there was also overwhelming evidence that highly active anti-retroviral therapy (HAART) was good opportunistic infection prophylaxis.

The proof is endless.

In Brazil HAART reduced TB by 80% in 255 HIV positive persons.

In South Africa, triple therapy reduced TB by 80% in 264 HIV positive persons compared with 770 non-HAART takers attending Somerset Hospital.

In Brazil the use of HAART and INH together reduced TB more than either alone.

The World Health Organisation has clear guidelines on the use of opportunistic infection prophylaxis and treatment.

INH is recommended by the WHO as a prophylaxis for people with latent TB.

It is also recommended that cotrimoxazole is used as a prophylaxis for people with AIDS, symptomatic HIV or a CD4 count below 200.

The WHO advises people living with HIV/AIDS to get vaccinations against influenza, hepatitis A and hepatitis B.

It also recommends the use of fluconazole for people with severe thrush, cryptococcal meningitis or those at high risk for penicillosis or cryptocossis (CD4 less than 100).

In South Africa Pfizer has donated fluconazole for specific diseases and infections in the public health sector, but in Nigeria people living with HIV/AIDS face a price tag of U$8 (R64) for three tablets.