Tuberculosis and HIV/AIDS are major global health issues. TB is the leading infectious cause of death worldwide and is a major killer of people living with HIV. About 10% of new TB cases in 2016 were among people living with HIV, most in Africa. Co-infection with TB and HIV accelerates the progression of both diseases. Effective diagnosis and treatment of both TB and HIV are needed, including antiretroviral therapy for those co-infected. While progress has been made, improved implementation of collaborative TB/HIV activities is still required.

1. TUBERCULOSIS & HIV/AIDS
SUBMITTED TO: SUBMITTED BY:
DR, SHAHANAZ CHOWDHURY DR. ISMAT JERIN
ASSOCIATE PROFESSOR & HEAD & MOHD BALAYET
PROGRAM COORDINATOR BILAL AHMED
DEPT. OF COMMUNITY MEDICINE. DR. FARJANA &
BUHS, DHAKA, BANGLADESH MS. FARJANA

2. Tuberculosis (TB)
 A highly contagious infection caused by the bacterium called Mycobacterium tuberculosis(MTB) that can
affect almost any part of the body but is mainly an infection of the lungs. Most infections do not have
symptoms, in which case it is known as latent tuberculosis.
 TB: Airborne Transmission

3. Key Facts:
 TB is the 9th leading cause of death worldwide and the leading cause from a single infectious agent,
ranking above HIV/AIDS.
 In 2016, there were an estimated 1.3 million TB deaths among HIV-negative people (down from 1.7
million in 2000) and an additional 374 000 deaths among HIV-positive people. An estimated 10.4
million people fell ill with TB in 2016: 90% were adults, 65% were male, 10% were people living with HIV
(74% in Africa) and 56% were in five countries: India, Indonesia, China, the Philippines and Pakistan.
 In 2016, an estimated 1 million children became ill with TB and 250 000 children died of TB (including
children with HIV associated TB).
 TB is a leading killer of HIV-positive people: in 2016, 40% of HIV deaths were due to TB.

4. Continue…
 Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. WHO
estimates that there were 600 000 new cases with resistance to Rifampicin – the most effective first-line
drug, of which 490 000 had MDR-TB. Globally, TB incidence is falling at about 2% per year. This needs to
accelerate to a 4–5% annual decline to reach the 2020 milestones of the End TB Strategy.
 An estimated 53 million lives were saved through TB diagnosis and treatment between 2000 and 2016.
 Ending the TB epidemic by 2030 is among the health targets of the Sustainable Development Goals.

5. Global impact of TB
 TB occurs in every part of the world. In 2016, the largest number of new TB cases occurred in Asia, with 45% of new
cases, followed by Africa, with 25% of new cases.
 In 2016, 87% of new TB cases occurred in the 30 high TB burden countries. 7 countries accounted for 64% of the
new TB cases: India, Indonesia, China, Philippines, Pakistan, Nigeria, and South Africa. Global progress depends on
advances in TB prevention and care in these countries.
 The South-East Asia region accounts for a disproportionately high number of global TB cases and Bangladesh is
seventh of 22 ‘high TB-burden’ countries. In 2014, there were 187,005 new cases of TB in Bangladesh and it was the
leading cause of death.
 Bangladesh has a five-year National Strategic Plan for TB Control (2015-2020), which aims to reduce the prevalence
of all forms of TB by at least 10% by 2020 and by 5% annually.

6. TB Prevention Strategy
 BCG vaccine - TB education – Early diagnosis - TB Treatment - Isolation
 WHO, USAID, CDC and many others organization is working with the government to fight against TB
worldwide.
 The ‘DOTS’ strategy is the key to success of Tuberculosis control in Bangladesh:
 In Bangladesh alongside with govt. National TB Control program & WHO, many NGO also taking part in
controlling TB from Bangladesh eg-
- Currently, BRAC covers 297 sub-districts from 42 districts, 7 city corporations with a population of
92.9 million people including 31 academic institutes, 41 prisons, 405 peripheral laboratories and 26 external
quality assessment centres.

8. HIV/AIDS
HIV - Human Immunodeficiency Virus
 H = Infects only Human beings
 I = Immunodeficiency virus weakens the immune system and increases the risk of infection
 V = Virus that attacks the body
AIDS - Acquired Immune Deficiency Syndrome
 A = Acquired, not inherited
 I = Weakens the Immune system
 D = Creates a Deficiency of CD4+ cells in the immune system
 S = Syndrome, or a group of illnesses taking place at the same time

9.  HIV continues to be a major global public health issue, having claimed more than 36.7 million lives so far. In
2016, 1.0 million people died from HIV-related causes globally
 The current estimates suggest an HIV prevalence rate of <1% among the most-at-risk population groups in
Bangladesh. The number of people living with HIV (PLHIV) and deaths from AIDS are announced on the
World AIDS Day every year by the MOHFW,
Key Facts:

10.  International efforts to combat HIV began in 1987 by WHO’s Global Program on AIDS in 1987. UNAIDS was
formed in 1996 to serve PLWHIV and uproot HIV. First HIV was diagnosed in 1981, now 36.7 million
 In Bangladesh first HIV screened in 1989 and now 12000, on ART 2111, Death 1000.
 Global scale-up of antiretroviral therapy has been the primary contributor to a 48% decline in deaths from
AIDS-related causes, from a peak of 1.9 million in 2005 to 1.0 million in 2016.
 Numerous prevention interventions exist to combat HIV -
 Effective prevention strategies include behavior change programs, condoms, HIV testing & counseling,
blood supply safety, harm reduction efforts for injecting drug users, and male circumcision and new tools
such as vaccines, are currently being researched.
The Global Response to HIV/AIDS

11. TB and HIV co-infection
 TB and HIV co-infection is when people have both HIV infection, and either latent or active TB disease.
HIV infection speeding up the progression from latent to active TB, TB bacteria also accelerate the
progress of HIV infection.
 Tuberculosis (TB) is one of the most common co-infections that people living with HIV can develop.
 TB is one of the leading causes of death among people living with HIV.

12. TB/HIV co-infection statistics
In 2016 :
 Deaths from HIV and TB co-infection: 374,000
 Deaths from TB alone: 1,300,000
 Deaths from HIV alone: 826,000
 So more people now die from TB than from HIV related infections.

13. Diagnosing TB in HIV
 The Stop TB Partnership’s Global Plan to Stop TB had a target that all patients with TB should be tested
for HIV and all HIV positive should undergo TB screening because HIV prevalence among TB patients
and TB prevalence among people living with HIV.
 It’s a bit difficult to diagnose TB in HIV positive individuals, than to diagnose TB in people without HIV
infection. Many people with HIV will have a false negative result from a TB sputum smear test. This can
result in a large number of cases of active TB disease going undiagnosed.

14. Antiretrovirals and
anti TB drug therapy
 ART has the potential both to reduce mortality and morbidity rates among HIV-infected people. ART
can’t cure HIV, but helps people with HIV live longer, healthier lives and reduces the risk of HIV
transmission.
 For adults with both TB and HIV infection, who need to receive both antiretrovirals and TB drugs, the
WHO guidelines recommend starting HIV antiretrovirals between 2 and 8 weeks after starting TB
treatment for those individuals who have a CD4 count of less than 200.

15. Conclusions:
 Global progress in implementation of TB/HIV activities is encouraging, but still limited and
late.
 The implementation of the "Three I’s“ need improvements: ICF (Intensified case finding is
progressing), but IPT (Isoniazid preventive therapy) is limited and IC (infection control) is
neglected.
 ART reduce the occurrence of TB infection in PLWHIV but is not enough. Combination with
other HIV (CTXp) Co-trimoxazol Prophylaxis & TB (3 I’s) control measures are needed.