KHOPOTSO: So vast are chances that every HIV-infected individual will develop tuberculosis that it’€™s public health policy to administer Isoniazid, a TB drug, as a preventative medicine to people living with HIV and AIDS when their CD4 counts drop. TB is a viral infection different from HIV, but its characteristics are very similar. Prof. Mary Edginton is a public health specialist at Wits University, in Johannesburg, and manager of the TB Care Centre at the 1600-bed Chris Hani Baragwanath Hospital, in Diepkloof, Soweto, south of Johannesburg.

Prof. MARY EDGINTON: TB is an enormous problem to patients because untreated, it kills. The mortality from untreated TB is high. It’€™s a problem because it’€™s a stigmatised illness. People don’€™t understand it. They are ostracised. They are thrown out by their communities and their families who also don’€™t understand it.

KHOPOTSO: According to the national Department of Health’€™s 2003 TB incidence figures, KwaZulu-Natal has the highest number of detected TB cases, at almost 77 000. The Western Cape, on the other hand, has the highest rate of TB infection ‘€“ 931 out of every 100 000 people are infected. Yet, the total number of detected TB cases for the same year was just over 44 000.

Dr LINDIWE MVUSI: When you look at the fact that KwaZulu-Natal has a high prevalence of HIV, it could be that HIV is fuelling the TB epidemic in the province. But I wouldn’€™t blame it entirely on the HIV epidemic because the epidemic has been there all along. It’€™s just that now we are seeing more cases who are co-infected, who have TB and HIV.

KHOPOTSO: That’€™s Dr Lindiwe Mvusi, manager of the National TB Control Programme in the Department of Health. Almost 280 000 cases of TB were detected in 2004, nationally. But it is not known as to what proportion of this figure can be attributed to HIV. One thing is for certain, though. HIV has made the TB field even more difficult.

Dr LINDIWE MVUSI: I think the challenge comes when we need to diagnose TB in people who are HIV positive because it’€™s difficult. Those will need to be referred to hospitals and that takes longer.

KHOPOTSO: Prof. Mary Edginton says HIV makes TB work much more difficult on two fronts.

Prof. MARY EDGINTON: First of all, it’€™s much more common. So, the services everywhere are overwhelmed. Secondly, we don’€™t always manage to see the organisms in the sputum of a person with TB who has advanced HIV infection. So, sometimes we have to use a whole lot of different criteria to make the diagnosis of TB. It may be clinical features, X-ray features, response to treatment.

KHOPOTSO: This is because the current diagnostic methods are ill-equipped to identify TB when HIV is a pre-disposing factor. Dr Lindiwe Mvusi.

Dr LINDIWE MVUSI: In terms of diagnostics, yes, the methods that we are using currently are outdated methods. And, hence, there is a movement globally to look at better diagnostic methods. But, this is mainly because of the lack of innovation in that area in terms of looking for better diagnostic methods and reluctance from people who have the money to invest in that field because when you look at it, TB affects mainly the poor, the Third World countries and no one wants to invest their money there because of the returns.

KHOPOTSO: The lack of the necessary high-tech diagnostics has adverse implications.

Dr LINDIWE MVUSI: You find that in most cases, TB is missed or diagnosed late in people who are HIV positive. Mainly because of the depressed immune system they will not respond as you would expect in a person who is HIV negative who has a strong immune system to respond to the infection.

KHOPOTSO: But Prof. Mary Edginton, says all is not doom and gloom when TB is finally detected.

Prof. MARY EDGINTON: The good news is that the same treatment still works. So, whether or not you are HIV-infected, TB is curable with the same drugs.

KHOPOTSO: Dr Lindiwe Mvusi explains the process.  

Dr LINDIWE MVUSI: The policy is that as long as they have a CD4 count of less than 200 they should get antiretrovirals and they should also be started on TB treatment, depending on how they are. Obviously, where they have a CD4 count of less than 50, then, you need to be careful if you introduce both at the same time. What is preferred is that if they are not already on antiretorvirals at the time when you diagnose TB, then, you start with the TB treatment. And then, as soon as they have settled on that, you introduce antiretrovirals because, again, you need to be careful of the side-effects because once they develop side-effects you wouldn’€™t know what drug is causing what.