EPISODE 20 - TB and HIV

HIV and TB are twin epidemics. Nearly 70% of all people with TB are also HIV positive. TB is also the most common cause of death in people living with HIV. But, TB is curable - including in people living with HIV. This makes understanding TB very important for people living with HIV and their families.

The first thing we all should know is that TB can also be prevented. TB is an airborne disease. When someone with TB coughs or sneezes small bits of saliva come out from the mouth and nose. These may contain the TB germ. When others in the room breathe these bits of saliva in, they may be infected with TB. Mostly TB will hang around inside your body without making itself felt. This is because the immune system is able to prevent the TB germ from becoming active. But at some point it may become active and TB disease develops. In people living with HIV this is much more likely to occur.

There are two things we can do to prevent TB. We can prevent the germs escaping into the air and we can change the air regularly through better ventilation. Lesley Odendal at the MSF clinic in Khayelitsha shows how to cough and sneeze into your elbow with your arm covering both the mouth and nose, preventing any germs from escaping into the air. Also, patients attending clinic can use masks to prevent inhaling TB germs. But that's not all. Lesley explains that having outside waiting rooms - which have a roof but no walls - allows the wind to take the TB germs away so that people waiting to see the doctor have fresh air at all times. Even the sputum room where people cough up stuff from deep in the lungs is open to the air. The clinic itself has windows on two walls so there is cross ventilation to help push old dirty air out and let fresh clean air in.

TB Prevention

Ayanda Qinga stays in Gugulethu and works at the Desmond Tutu Aids Foundation. She developed TB when her CD4 count was 87. Obviously, she had to start taking TB medication to cure her TB. But should she start on ARVs as well or should she wait? As Dr Linda-Gail Bekker explains, the reason for waiting is that TB medication consists of four strong drugs, and ARV medication requires three drugs. All these drugs taken together can cause side effects - especially for the liver. But she has found in a big study that it is much better to start the ARVs as soon as possible once TB medication is started - usually within two weeks. This is because when someone has a very low CD4 count like Ayanda had, she was vulnerable to many diseases which might lead to death. It is much better to start the ARVs and deal with the side effects than to wait. This is what happened in Ayanda's case and she experienced almost no problems at all taking both TB medicines and ARVs together. Today she is healthy and able to care for her family thanks to the good treatment she received. Ayanda's challenge to anyone living with HIV and TB is that she got better and so can you!

TB and ARVs

Young Anathi lives with her foster mother Helen in Khayelitsha. Anathi is 8 years old and on ARVs. She started coughing and sweating at night and was diagnosed with TB for the second time. But she didn't get better. She had a discharge from her ears. She had drug resistant (MDR) TB that was responding to the usual medication used to treat TB. After a long time in hospital she improved. Now Helen is giving Anathi her pills at home - six pills for MDR and her ARVs. "It's a mission," says Helen. Sometimes Anathi doesn't want to take her pills so Helen needs great patience and tolerance to keep up the treatment of 18 or maybe even 24 months. But Anathi is looking beautiful and she is determined she is going to do it. Anathi's story shows that even MDR TB treatment which requires more powerful medicine can be combined with ARVs. TB can be beaten!

MDR-TB and Children