TB and HIV

I've been a bit bad at writing this blog recently, I guess as I've spent more time out here in the Gambia my "wow" factor on all the interesting things has worn off.
I can only write a brief blog today as I'm off on a trip to Senegal today for a weekend at the beach with Sophie.

I've been doing quite a bit of work on fostering co-operation between the TB department and the HIV department here at the MRC: these two diseases are studied separately here, but in clinical practice here, there is often dual infection, ie someone with both tuberculosis and HIV/AIDS.

The combination of TB and HIV is an important one because these two diseases are essentially synergistic : HIV promotes the spread of TB, and TB is the major killer of people with HIV. The HIV epidemic around the world is one of the main reasons that TB is "making a comeback", especially in sub-Saharan Africa. They interact in a whole bunch of more complicated ways also: TB is more difficult to diagnose in someone with HIV, drug side-effects are more common for both diseases in co-infection, HIV+ people are more vunerable to catching/developing TB ... the list goes on.

This was all put into reality for me this week when I had my first (confirmed) HIV + TB patient. Sadly, he died within in few days of first coming to the MRC - people here often see "western" medicine as a last resort only, and turn up when disease is very advanced. The guy had looked dreadful when I saw him, with all the typical features of both infections. After he died, I then had the unenviable task of explaining to his (only) wife what he had died of, and encouraging her to have HIV testing herself. In some ways, I was breaching the confidentiality of the husband by doing this, but I really feel that you have to concentrate on doing what you can for who you can help.

We estimate about 5% of Gambians with TB may be HIV positive. If you compare this with about 50% of TB patients with HIV in South Africa, you see where the epidemic might be going. In West Africa, it all really depends on action taken over the next decade, but who knows what is going to happen here ?