HIV AND TB-ALTERNATIVE THERAPIES PLUS ALLOPATHIC DRUGS BY

Author: Dr. Pradyut Waghray MB(Chest), MRCP(UK), FCCP(USA)
Director Kunal Insitute Of Medical Specialties Pvt. Ltd.,Hyderabad
Sr.Consultant Pulmonologist Apollo Hospital, Hyderabad

Over the last two years 140 cases of HIV who also has associated TB were studied, HIV was confirmed by Western Blot Test.

Sex   
Males       11(82%)
Females    24(18%)

Age Groups:
Males       22 to 44 Years
Females    19 to 32 Years

PULMONARY TB            108 (77%)
Upper Lobe Infiltrates     68 (62%)
Lower Lobe Infiltrates     12 (11%)
Cavitation                     25 (23.5%)
Miliary T.B                      3 (2.5%)

EXTRA-PULMONARY TB                 32 (23%)
INTRA-THORACIC APENOPATHY     14 (44%)
Cervical Lymphadenopathy              4 (12%)
Pleural Effusion                            10 (32%)
Abdominal TB                                1 (3%)
TB Meningitis                                1 (3%)
Tuberculoma of Brain                      1 (3%)

TB can occur throughout the course of HIV infection. The clinical expression is dependent on the degree of host immunosuppression(CD$). HIV patients with early disease presents like reactivation TB with classic upper lobe infiltrate and cavitaion. In contrast, advanced HIV patients present with more atypical patterns like -

More primary type presentation with intrathoracic adenopathy
Lower zone lung involvement
Pauci-Bascillary disease
Poor granuloma formation with less cavitation
Extra-Pulmonary disease more common
Co-infection with PCP and other microbes more likely
Sputum positivity is less likely than HIV non-infected patients
Sputum positive for AFB: 58 (42%)
Sputum negative for AFB: 82 (58%)

CLINICAL FEATURES

Cough              :     76 (54%)
Haemooptysis    :    34 (24%)
Chest pain        :    19 (14%)
Breathlessness   :    11 (8%)

With constitutional symptoms like fever, night sweats, tired ness and loss of appetite.

TREATMENT

Treatment is characterized by

Similar regimens to HIV non-infected
Response rates are similar
Rate of adverse TB drug reactions are more frequent
Certain antiretroviral drugs, especially protease inhibitors cannot be used concurrently with rifampicin
MDR TB is likely more common
The higher mortality is due to the underlying HIV infection
Treatment received
2EHRZ \ 7HR along with alternative therapy for HIV given simultaneously AVALMIC-1(200mg), AVALMIC-II(250mg) followed in some advanced cases of HIV by KAPHUOG 200mg and MEDHAMRUT-200mg for 2 to 4 months.

RESULTS
120(85%) patients completed the full course of Anti-TB treatment
20(15%) patients defaulted
52 of 58(90%) sputum positive patients became sputum negative at the end of six months Radiological improvement occurred in 94 of 108(88%) patients with pulmonary TB Viral Load was reduced and absolute CD4 counts were increased.

CONCLUSION
HIV increases a person's susceptibility to infection with mycobacterium TB by predominantly an immunological response which involves secreation of IL6 and TNF-alpha. The drugs AVALMIC-I and II probably boost the vitality(immunity) of the individual and can be taken along with anti-tuberculous medications simultaneously, without causing and drug interactions, thus resulting in faster healing of TB in HIV infected patients.

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