Out of 1,804 HIV-TB co-infected patients, 458 lost lives: MDACS study

Out of the 1804 HIVTB coinfected patients between 2018 to 2021 in Mumbai a total of 325 died during their treatment with 133 succumbing to the illness in the posttreatment period revealed a study published in the European journal Tropical Medicine and International Health this month These findings are part of a study conducted by the Mumbai District AIDS Control Society MDACSldquoThe overall mortality remains high the study suggests examining the factors associated with death in HIVTB coinfected patients in the city The study relied on secondary medical data of the cohort of 1804 patients collected from 16 antiretroviral therapy ART centers affiliated with MDACS The published study is authored by Dr Srikala Acharya Dr Vijaykumar Karanjkar Dr Sunil P Bhamre Dr Amol Palkar Dr Dhirubhai Rathod and Dr Maninder Singh SetiaDr Srikala the lead author said It is important to understand that the results of the study are limited to this cohort and many conclusions cannot be drawn for all HIVTB coinfected patients However there is one thing that we can be certain about is that early diagnosis of both diseases and their treatment plays a crucial role in determining mortalityThe study also sheds light upon is our understanding of the postTB treatment phase in HIVTB coinfection patients For advanced HIV disease or advanced TB disease there could be so much irreversible damage that could be happening inside the body Even after the treatment was over the clinical condition of many patients in this cohort did not improve and they continued to have some symptoms with eventual demise Dr Srikala saidMost out of the 1804 people in the study were in the age range of 19ndash39 4337 and 40ndash59 4837 The majority were men 6237 and lived in Mumbai 5437 of the cohort had pulmonary tuberculosis and about 4137 also reported tuberculosis in the past Meanwhile 221 individuals in the study were recorded as lost to followupGanesh Acharya a citybased HIVTB activist and a survivor said The tests for HIV and TB need to be included as routine tests If a person is diagnosed with diabetes or undergoing any surgery they can be asked get tested for TB or HIVWhile we do not know how many of the total 1804 individuals in the study fell into the highrisk category of contracting HIV according to Acharya there is a need to move beyond traditional diagnostic strategies We are not moving beyond traditional strategies of early diagnosis beyond focusing on highrisk people We now need to include everybody in HIV testing he saidHowever Dr Srikala said that getting tested is an individuals responsibility and is also a very personal choice HIV testing or testing for other sexually transmitted diseases needs to be normalised in the society which even after so many years is lacking to a certain degree Our outreach programs and awareness programs continue to be carried out she saidThe study also noted that age was also another factor that decided the fate of an individual Of the total 1258 individuals for whom we had data after the completion of antituberculosis treatment 133 10637 died during the followup period The proportion of deaths was high in patients aged 60 years and above 28037 age was significantly associated with mortality in the posttreatment completion period it mentionsThere were limitations to this study one of which is we do not know if there were any other infections that contributed to mortality in the cohort This is more important because the time frame of this study includes the years of the pandemic when COVID19 was at its alltime high The authors stressed the importance of monitoring the posttreatment condition of the patients which they said should be considered in determining the success of TB control programsEarly identification of TB and HIV disease and the use of rapid pointofcare tests for the diagnosis of TB are needed across all healthcare facilities the study concludedLeading factors for death People with lower CD4 counts which are Tcells also known as immune cells had a higher risk of mortality A serious drop in CD4 count is common among advanced HIV patients Additionally delays in diagnosis and treatment also contributed to a persons death A significant death rate was also observed in ARTnaive patients with TB This refers to patients who are HIV positive but their status is only known after they are diagnosed with TB later once a patient tests positive for TB guidelines recommend authorities to check their HIV status The delayed diagnosis also means delayed antiretroviral therapy for HIV treatment It is not uncommon for this to occur as TB presents itself with symptoms early on while that is not the case with HIV