Tuberculosis and HIV AIDS

2021-04-14 05:02 PM

When TCD4 is less than 200 / mm3, there is usually acute and severe TB such as tuberculosis, meningitis, and multi-organ tuberculosis. There may be special forms of TB such as: tuberculoma in the brain and cold abscesses in the chest wall.

Outline

The HIV / AIDS epidemic is spreading around the world. According to the World Health Organization, each year about 2.7 million people is infected with HIV, the cumulative number in 1998 is 34 million, each year up to 60% of people infected with HIV become AIDS. Although a lot of prevention measures have been taken and a lot of effort has been taken, it seems that this disaster has not been prevented. In 2004 alone, there were 4.9 million people infected with HIV globally, nearly twice as high as the 1998 forecast, of which 4.3 million were adults (15 - 49 years old), 570,000 of which were children under 15 years old and killed 3.1 million others. As of December 31, 2004, humanity has had 39.4 million people infected with HIV since 1981. The rapid spread of HIV infection in many regions has seriously affected the diagnosis and treatment of tuberculosis and the TB program was not effective. The International TB Conference held in Boston in 1990 stated: because the impact of HIV / AIDS infection, TB is not only not decreasing but increasing. In countries where TB is common, between 30% and 60% of adults are infected with TB. The World Health Organization has estimated that 2 billion people have been infected with TB so far. The companionship of these two evil diseases is putting humanity in great challenges. That is why the World Health Organization guides: when TB occurs in HIV-infected people, these people are considered to have turned AIDS. In some countries near the Sahara, 30% to 70% of TB patients have HIV co-infection, while in Southeast Asia and Latin America 20%. Tuberculosis ranks first among opportunistic infections and is also the leading cause of death (between 30% and 50%) of people living with HIV / AIDS. According to the announcement of the National AIDS Committee, as of May 31, 2005, there were 95,512 cases of HIV infection nationwide, of which 15,539 had turned into AIDS and 8,965 cases died. From the first case of HIV-infected TB detected at Pham Ngoc Thach tuberculosis hospital in late 1992, to 1999 the HIV prevalence rate among people with tuberculosis was 1 to 1.5%. According to the announcement of the National AIDS Committee, in the first 6 months of 2005, the rate of HIV-infected TB patients was 4.47%, particularly in big cities such as Hanoi, Ho Chi Minh City, Hai Phong ... double. by 1999, the HIV prevalence rate among people with tuberculosis was 1 to 1.5%. According to the announcement of the National AIDS Committee, in the first 6 months of 2005, the rate of HIV-infected TB patients was 4.47%, particularly in big cities such as Hanoi, Ho Chi Minh City, Hai Phong ... double. by 1999, the HIV prevalence rate among people with tuberculosis was 1 to 1.5%. According to the announcement of the National AIDS Committee, in the first 6 months of 2005, the rate of HIV-infected TB patients was 4.47%, particularly in big cities such as Hanoi, Ho Chi Minh City, Hai Phong ... double. 

Recall some of the basic points of the disease association

There is a special relationship between tuberculosis and HIV infection. These two diseases interact with the pathological spiral, resulting in shorter lives of HIV-co-infected TB patients.

Relationship between HIV infection and tuberculosis

HIV attack destroys TCD4 lymphocytes, leading to a decrease in the body's resistance to the growth of tuberculosis bacteria, causing tuberculosis to speed up development, and shorten the time it takes to transition from TB infection to disease. HIV-infected people are 10 to 30 times more likely to develop TB disease than non-infected people and from TB infection to TB infection 10% for 1 year. The chance of getting TB disease for people with HIV is 50%. Tuberculosis usually progresses rapidly and spreads.

Relationship between tuberculosis and HIV infection 

The cellular destruction of tuberculosis releases cell-mediating chemicals. Substances such as tumour necrosis factor alpha (TNFα - Tumour Necrosis Factor alpha) and Interleukin 6 (IL6) stimulate HIV to multiply faster, causing TCD4 to destroy more, leading to more severe immunodeficiency.

Characteristics of tuberculosis infected with HIV / AIDS

Symptom

Symptoms of tuberculosis

In an early stage, a person with HIV (+) TB can have the same symptoms as a person without HIV. In the late stage, atypical symptoms are confused with those of other opportunistic lung diseases or with those of AIDS. 

Pulmonary tuberculosis still accounts for the highest proportion with suggestive symptoms such as prolonged cough, fever and often with lesions near the lungs: pleural tuberculosis, tuberculosis - bronchial tuberculosis; followed by tuberculosis: peritoneal, pericardial, and lymphadenopathy with systemic lymphadenitis features. When TCD4 is less than 200 / mm3, there is usually acute and severe TB such as tuberculosis, meningitis, and multi-organ tuberculosis. There may be special forms of TB such as: tuberculoma in the brain and cold abscesses in the chest wall.

According to Nguyen Viet Co et al (1999), in 129 HIV (+) TB patients, there were 68.21% tuberculosis; 31.79% extrapulmonary TB, mainly pleural tuberculosis. Symptoms of pulmonary tuberculosis include prolonged coughing (97.45%); weight loss (96.12%); fever (72.88%).

Symptoms suggestive of HIV / AIDS infection

Caution should be exercised when the patient comes to a TB specialist when it is not confirmed HIV infection or if the patient is not known. A TB patient thinks of concurrent HIV / AIDS infection when having the following symptoms:

Full body lymphadenopathy.

Oral candidiasis.

Persistent diarrheal.

Herpes recur many times.

Dermatitis.

Kaposi sarcoma masses on the skin.

According to Nguyen Viet Co et al: other symptoms of TB infected with HIV / AIDS are:

 Lymph nodes (24.03%).

Diarrheal (9.30%).

Dermatitis (16.27%).

History suggestive of HIV / AIDS infection

A TB patient is suspected of having concurrent HIV / AIDS infection if he / she has a history of: drug addiction first (Nguyen Viet Co 1999: 90%), having sex with many people, children born from HIV-infected mother from an area with high HIV prevalence ...

Test

Look for TB bacteria in the sputum

Few acid-resistant TB bacteria are seen by direct microscopy, so it is necessary to use culture techniques, especially rapid culture techniques: MGIT, BACTEC 460. Atypical antacid bacteria resistant bacilli may be encountered. such as: MAI, M. Kansasii, M. Xenopi ... are the causes of the disease.

Chest X-ray

Tuberculosis lesions in people with HIV (+) have the following characteristics:

Often broad, seen in the lower lobe, spread both fields.

Basic form: mainly ulcers, less cavernous and fibrous lesions.

Combination: mediastinal lymph nodes and pleural effusion. 

According to Nguyen Viet Co et al: extensive lesions in the lungs - 61.36%; nodules and infiltrates - 98%; cave - 11%.

Mantoux reaction

The Mantoux reaction in people with HIV (+) is positive with low incidence. A positive reaction is acceptable when the size of the reactor is 5mm. When in AIDS the reaction is completely negative.

Other tests

Due to atypical symptoms, tuberculosis bacteria are rarely found in sputum, and X-ray images are confused with other diseases, other tests are needed to increase the accuracy of a definitive diagnosis.

Chain polymerization (PCR).

Lymph node biopsy: need to distinguish between the lymph nodes of HIV and the lymph nodes.

Blood culture for TB bacteria: in the case of millet TB, blood culture shows that the bacillus grows at a high rate.

Diagnose

Implementing the quadrants

TB disease in HIV / AIDS infected people faces many difficulties in diagnosis, especially in the late stage of immunodeficiency:

Symptoms are not clear.

TB bacteria are difficult to find. 

Mantoux reaction was negative.

That is why it is necessary to rely on the properties of the lesions on the lung film, culture of tuberculosis bacteria, blood culture if it is millet TB, and fluid testing as well as biopsy if it is extrapulmonary.

Differential diagnosis

First of all, it is necessary to distinguish pulmonary tuberculosis from other opportunistic infections in the lungs such as: pneumonia, lung abscess, pneumonia, lung disease do Pneumocystis carinii.

Treatment

Drug treatment

Recommended by the International TB Association and the World Health Organization.

Treatment can be initiated from the moment an HIV (+) patient is suspected of having TB.

Take 2 to 5 anti-TB drugs like a person without HIV. 

The use of streptomycin and thioacetazone is not indicated in the regimen.

If streptomycin does not comply with the principle of anti-infection, it will transmit disease to other people, including medical staff (by poking a needle in the hand), thioacetazone or causes side effects, especially eczema, scab, pain and blistering.

The Vietnam anti-TB program prescribed the first regimen used for treatment is 2SRHZ / 6HE. If that fails, then relapse then use regimen 2 SRHZE / 1RHZE / 5R3H3E3.

When injecting streptomycin must strictly adhere to the anti-infection procedure.

According to the World Health Organization 1997, the treatment response of HIV (+) TB patients is similar to that of non-HIV infected people, but depends on the stage of HIV infection and the severity of TB injury. However, be careful:

Diagnosing too widely cases of pulmonary tuberculosis AFB (-).

Wrong diagnosis of AFB (+) pulmonary tuberculosis.

Treatment is not strictly controlled. 

Low cure rate.

High mortality.

The dropout rate is high due to drug side effects, discouragement of the patient and the medical staff.

High recurrence rate.

The risk of drug resistance increases. 

Death: 32.09%.

Treatment completion: assessed as 49.38% cured (AFB negative, lesions improved, pleural fluid free, lymph node enlargement).

Counselling and care for TB infected people with HIV / AIDS

In order to treat tuberculosis patients with HIV / AIDS, in addition to using anti-TB drugs, counselling and comprehensive care must also be performed.

Advice for HIV / AIDS workers:

Counselling is the process of communication and supportive influences between the counsellor and the patient or the patient's family or relatives in order to:

Providing essential information about TB, HIV / AIDS to help them know about the disease and continue with their lives?

Convince them to take preventative and therapeutic measures to protect themselves and others, and participate in disease prevention activities.

It is very necessary to consult because:

HIV / AIDS has not had a preventive vaccine, has not been cured, only drugs that inhibit the growth of the virus. Once infected, in the first time when the infected person is not immunocompromised, it is still healthy, so it is easy to spread the disease in the community.

People who know HIV / AIDS or TB / HIV (+) fear, feel sad, afraid of being shunned and discriminate, so they often take negative actions: refuse treatment or act aggressively. infect others, commit suicide ...

The prevention of HIV / AIDS transmission still works by changing behaviour.

Tuberculosis can still be cured in people living with HIV / AIDS where adherence to treatment principles is paramount and the use of anti-TB drugs is strictly controlled and side effects are detected promptly.

Some counselling skills: 

When counselling a TB / HIV-AIDS patient, relatives and family of the counselor must:

Listen carefully to the patient's story and questions. 

Try to understand the question, the story.

If you do ask again, you should use questions that are understandable, understanding and respectful.

Do not criticize behaviours. 

Provide only the correct information.

Master everything you need to know about TB and HIV / AIDS.

Taking care of TB patients with HIV / AIDS

People with TB and HIV / AIDS need special care at the hospital and at home.

When a fever:

Take off your clothes.

Drink a lot of water. 

When the temperature is 39 0 C or more: take antipyretics.

With diarrheal:

Electrolyte rehydration (at home: oral ore sol, oral).

Prevention: clean eating and food safety.

When there is skin damage:

Rinse with salt water, blot dry. A sterile dressing. 

Limit scratching, just rub, cut nails short.

Change clothes in separate bags, soak Javelle 1% water for 20 minutes before washing. Washers must use gloves until drying is complete. Clothes that are not reused are burned or soaked in Javen 1% water after 20 minutes to put them in the trash.

Dental hygiene:

Brush your teeth with a soft brush after eating. 

Rinse mouth with antiseptic solution.

Physical pain: 

It is caused by long-term lying down or another illness such as Herpes zoster, a sensory neurological disorder.

Relax, massage, lie on a soft mattress.

Use pain relievers: paracetamol, aspirin ...

Sad anxiety, depressed:

There should be comfort and encouragement from relatives, reputable elders, especially people in the same situation.

Barbiturates are used only when clearly needed.

Prevention of TB for HIV / AIDS infected people

BCG vaccine

BCG vaccine is a live vaccine. If given to a child infected with HIV, there is a risk of the TB bacteria spreading to the system. However, as recommended by the World Health Organization and the Vietnam TB program: when a child with HIV is healthy, he/she will still be injected with BCG to prevent the disease.

Medicine

People with HIV infected with TB, living in areas with severe TB disease or exposed to a strong, near, and prolonged source of transmission, should be protected with medication:

INH with therapeutic doses for 6 months to 1 year.

Rifampicin or Rifabutin at therapeutic doses has better TB prevention in people with TCD4 lower than 200 / mm3.

However, due to the high resistance of tuberculosis drugs to anti-TB drugs, tuberculosis in Vietnam is still common, with low income, so the use of medicines to prevent TB for HIV-infected people has not been indicated.

Preventing HIV transmission while taking care of sick people 

The risk of HIV infection can come from: infusion to the patient, taking blood for testing or performing procedures: extracting the lymph nodes, draining the lung (gas, fluid), respiratory resuscitation ... even laundry.

Avoiding contact with the blood of the patient is the first step.

Wear gloves.

Do not let sharp objects: needles, scalpels, glass fragments of tubes containing patient's blood ... pierce the skin.

Wear glasses to avoid splashes of blood in your eyes.

Use shadows and masks rather than blowing your mouths.

Soak the linen in Javen water for 20 minutes then put-on gloves to wash.