Tuberculosis (TB), a potentially serious infectious bacterial disease that mainly affects the lungs, is considered as one of the most common opportunistic infection (OI) among people living with HIV (PLHIV). However, according to medical experts, TB is no longer viewed as a dreaded infectious disease to PLHIV in recent years owing to the heightened level of awareness about the disease among the infected population.
According to WHO, a total of 1.5 million people died from TB in 2020 (including 214 000 people with HIV). Worldwide, TB is the 13th leading cause of death and the second leading infectious killer after COVID-19 (above HIV/AIDS). In fact, India recorded the highest burden of TB as per global Tuberculosis report 2016 with 24 per cent of global prevalence and 21 per cent of total global TB deaths.
Taking serious note of the high figure of TB prevalence rate in the country, the Government of India (GoI) had made a target to eliminate TB spread in the country by the year 2025 in the Union Budget of 2017-2018.
It may be mentioned that being immune compromised persons, PLHIV are more susceptible to developing active TB and risked TB reactivation of patient with the latent TB.
Manipur being one of the states having high HIV infected person with an estimation of adult HIV prevalence rate of 1.15 per cent as per the 2020 latest report, at one point of time TB was one of the most common causes of death among this population in the state. But in recent years, awareness has been created extensively and the situation is getting better, according to medical experts as per their experience. The state also registered a decline in the number of TB reactive cases.
According to information received from the State TB Cell located at RD Wing Lamphelpat in Imphal West, based on NIKSHAY (National Tuberculosis Elimination Programme) report, the number of TB reactive cases was 2,405 in the year 2017; 2,865 in 2018; 2,656 in 2019; 1,622 in 2020 and 1,882 in 2021. Out of this figure, TB reactive amongst PLHIV in 2017 were 129, in 2018 were 139, in 2019 were 119, in 2020 were 108 and in 2021 were 113.
The state also reported a decline in the number of deaths due to TB in the year 2021. The total number of persons who died due to TB infection was 55 in 2017, 73 in 2018, 64 in 2019, 63 in 2020 and 44 in 2021 (till October).
The State TB Cell also noted the number of TB patient treated successfully was 1,886 in 2017; 2,290 in 2018; 1,021 in 2019; 1,300 in 2020 and 472 in 2021 (till October). Patients who failed to follow up their treatment was 122 in 2017, 91 in 2018, 57 in 2019, 50 in 2020 and 29 in 2021 (till October).
Speaking exclusively to the Imphal Free Press, a senior state medical officer, Chief Medical Officer of Imphal East district, Dr Hidangmayum Diamond Sharma said that infectious tuberculosis disease caused by a bacterium called Mycobacterium tuberculosis is one of the co-infectious diseases among PLHIV group as they are immune compromised people. Mycobacterium tuberculosis usually attacks the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain, though not everyone infected with TB bacteria becomes sick.
There was a time where TB was viewed as one of the dangerous OI that would even lead to loss of life. But situation has gradually improved over the years. Death toll due to TB infection in the state has drastically reduced and drug resistant TB has also declined.
Sharma, who has been treating PLHIV patients for over three decade further said that based on his years of experience, the main reason for decline in TB severity amongst PLHIV is due to the increase in health consciousness and health seeking behavior developed in recent years.
“Manipur could be one of the states in Northeast India where awareness level of HIV and AIDS is increasing nowadays because of its high prevalence rate.”
Implementation of various national programmes in the effort to control HIV has encouraged PLHIV to upkeep their health condition, he said. He also said that a lifelong therapy for PLHIV called Antiretroviral Therapy (ART) treatment also helps them to adhere to TB treatment. As a result of it, the occurrence of TB drug resistance amongst PLHIV has decreased remarkably.
While mentioning about TB treatment, the CMO of Imphal East district said that the Government of India has launched various programmes to control TB in India. In 1997, the Revised National Tuberculosis Control Programme was launched where directly observed treatment (DOT) system was implemented. Then the National Tuberculosis Elimination Programme was launched with a target to eliminate TB in the country by 2025. To achieve it, the state government is putting all effort by spreading massive awareness across the state.
Sharma further told the Imphal Free Press that treatment of TB for both PLHIV and general population is the same. The cases of TB drug resistance are more among the general population than PLHIV. TB-infected general population usually hardly completes the normal six-month treatment course. Many often stop the treatment when they experience improvement in their health condition with the perception of being cured completely. But on the contrary to it, PLHIV strictly compliance this six months course because they now understand that their health will deteriorate if treatment is neglected.
“Earlier TB and ART treatment couldn’t go simultaneously as drugs used in both treatments are very strong that are known to have consequences of side-effects. But with the development of medical science, both the therapy can go concurrently,” Sharma said.
He also said that “the benefit of allowing concurrent therapy is that ART being a lifelong therapy, the chances of forgetting to take TB medicine lessens. This really helps to maintain complete course of TB therapy. However, food supplement or at least intake of vitamin is much needed along with medication to prevent liver damage to the patient,” he observed while informing that adherence to therapy keep TB severity at bay amongst PLHIV.
While appealing to those PLHIV who are hesitant to undergo ART and TB treatment, the medical officer said that the test and treat policy of the National AIDS Control Organization enhanced quality of living to PLHIV.
As such, every PLHIV should access the ART and TB treatment so that they could lead a healthy and long life. Besides this, PLHIV and TB are public health issues. So until everyone is safe no one is safe. In order to achieve the target of TB elimination by 2025, it is very much necessary to improve TB status among this group too.