Human Immunodeficiency Virusand Tuberculosis Author: Kristen Nowakowski
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Date: May 18, 2010


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The contagion of HIV occurs through the contact of an infected individual's of bodily fluids with the skin and mucous membranes of a noninfected individual. Once inside, it attacks the immune system, and hinders the body's ability to fight off infections. In doing so, the human immunodeficiency virus often gives way to the acquired immune deficiency syndrome, AIDS.

Tuberculosis on the other hand, is a highly communicable airborne disease which, while treatable, can be highly fatal if unattended.

When combined, the general state of the human body quickly deteriorates. For many reasons it has become difficult to treat an individual when they habour both diseases. So far, there is no general agreement on how to treat the two diseases when co-infection occurs.


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The original reason why Alex and I were interested in researching this particular topic, Tuberculosis, stemmed from a curiosity of how such a highly communicable disease could be so treatable and yet so prevalent.

As we began to conduct further research and inquiry on the subject matter, we soon gathered that the intricacy surrounding the prevalence of Tuberculosis was not due to some complex nature of the disease, but the connection between the Tuberculosis disease and the Human Immunodeficiency Virus (the AIDS virus).

While in both of our research, we evaluate the association between the two diseases, I will be focusing more on the Human Immunodeficiency Virus (HIV) and its impact on the magnification and acceleration of the Tuberculosis disease, along with an evaluation of the development of the two diseases.


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HIV/AIDS
HIV stands for the human immunodeficiency virus and the cause of acquired immunodeficiency syndrome (AIDS).
Structure:
HIV is a retrovirus and of the genus Lentivirus. It contains two identical strands of RNA, the enzyme reverse transcriptase and a phospholipid envelope which have glycoprotein spikes.

Retroviruses are RNA containing viruses that possess the reverse transcriptase enzyme which they use to transcribe themselves into DNA and transfer genetic material into the DNA of the host cell.

Once inside, HIV seeks and destroys a particular type of white blood cell, crucial to the normal functioning of the human immune system (enabling the body to fight off diseases), the CD4+ T cell.

The Lentivirus genus includes the subspecies HIV-1 and HIV-2 which are the viruses that cause/can lead to AIDS (Acquired Immune Deficiency Syndrome), the most advanced stage of HIV infection (Tortora, Funke, and Case 540).

Human Immunodeficiency Virus Type 2 (HIV-2) was discovered in 1986. But this second type of HIV is believed to have been present in Africa many years prior. HIV-2 is less infectious, and weakly contagious, not often found outside West Africa. Some of the drugs used to treat HIV-1 are ineffective in treating HIV-2. The infectiousness of HIV-2 increases with progression of the virus (Johnson, 2010).

Timeline:
It is now believed that HIV originated through the mutation of a virus that was endemic within the wildlife regions of central Africa.

In 1982 the first AIDS case is reported in Africa

The term “GRID” of “gay-related immune deficiency” becomes increasingly used by the media and health care professionals, erroneously implicating an inherent link between homosexuality and AIDS

1984: United States Dr. Robert Gallo identifies HIV as the cause of AIDS
8,000 confirmed cases in the U.S.

1 year later – at least one HIV/AIDS case has been reported in each region of the world
The first HIV test licensed by the U.S. Food and Drug Administration (FDA) detects antibodies to HIV in blood. Blood banks begin to screen the U.S. blood supply.

1987: First antiretroviral drug is approved by U.S. FDA
100,000 to 150,000 cases of HIV and AIDS

1992: The FDA licenses its first rapid HIV test, providing results in just as little as ten minutes
Over 1 million people living with AIDS

The U.S. FDA approves HIV urine and home testing and collection kit: 1996

1998: The first large scale human trials for an HIV vaccine begin
AIDs is now the #1 cause of death for U.S. men 25 to 44 years of age

31 million people worldwide are now living with HIV in 2003

There are 4.9 million people who were newly infected in 2005 and 40.3 million people living with HIV/AIDS worldwide
In 2006 it was estimated that approximately 56,000 people had contracted HIV in the United States (CDC, 2010).


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At the end of 2007, more than 1 million individuals within the United States had been diagnosed with AIDS. Over 50% of them died because of it.
Infection
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Disease pattern studies discovered that HIV could be spread through sexual intercourse (semen, vaginal secretions), contaminated needles, infected blood, and from infected mothers to their newborns via breast milk (Tortora, Funke, and Case 540). Essentially, from the transmission of the infected person’s body fluids coming in contact with an uninfected individual’s skin or mucous membranes (Zegin, 2010).

Warning signs of HIV infection-


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Yet regardless of what the symptoms are listed above, individuals are not encouraged to attempt to diagnose themselves for AIDS. Many of these symptoms are similar to those of many other diseases. The only way to determine whether you are infected is to be tested for HIV infection (Zegin, 2010).

While some people feel symptoms when newly infected with HIV, most people do not.

In fact, many people living with HIV may appear, even feel healthy for several years… Another reason how and why the disease spreads so easily. Because of this, it is estimated that there are millions of people living with HIV without even knowing it.

But regardless of whether people feel healthy, HIV is still taking effect on the body.

Tests
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There are many reasons why people fail to get tested for HIV

Lack of access to testing services

Fear of stigma and discrimination

Fear that the test will be positive

And lack of access to treatment

There are a number of different tests used to determine whether a person has become infected with HIV. One of the most common, most appropriate tests for routine diagnosis of HIV among adults is the HIV antibody tests. (Avert, 2010).

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If an individual has a positive HIV test it means that they are infected with the virus and can pass it on to others. A positive HIV test does not necessarily indicated that a person has AIDS (Zegin, 2010).

If a person has a negative test result, this means that HIV antibodies were not detected within the individual’s blood (or other bodily fluids or vertebrates).


Treatment:

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Tuberculosis

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To give a very brief introduction into Tuberculosis before we explore the dynamics of the co-infection, “TB” is short for tuberculosis. The disease is caused by the bacterium Mycobacterium tuberculosis. TB is an airborne disease that is and can be communicated via throat coughs, sneezes, speaking and singing. It is NOT, however, transmitted via handshakes, sharing food, touching bed linens/toilet seat, sharing toothbrushes or kissing.
TB kills approximately 1.7 million people per year and nine million will develop active TB in a given year (DWB, 2008).
Lastly, there are two different types of TB: Latent TB and TB Disease

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TB, 2006


TB and HIV

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Connection:


TB is one of the leading causes of death for individuals living with HIV/AIDS. And people living with HIV/AIDS are up to 50 times more likely to develop active TB in a given year, compared to HIV-negative individuals.
While new TB cases have tripled in countries with high HIV prevalence, in the past 15 years alone, less that 1% of individuals living with HIV/AIDS were even screened for TB (DWB, 2008).
This is one of the major reasons why the prevalence of the TB/HIV co-infection is already so high, and continues to rise. Not only are sensitive diagnostic tools lacking for co-infected patients, but treatment is often laborious, complicated and highly extensive.


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Treatment:

It is most important for co-infected patients to be closely monitored during any type of treatment. This must be done to ensure that they are not hurt by the side effects from taking TB and HIV medications together.

Supervision is important for ensuring the TB medications do not interacting with patients’ HIV medicines in a way that could alter the effect.


Dr. Salim Abdul Karim from the University of KwaZulu-Natal in South Africa – “The TB drugs induce some key enzymes in the liver that result in the anti-retroviral drugs being metabolized more quickly,” Essentially, this makes the anti-retrovirals less effective.

Some patients become sicker after taking the TB drugs (body’s immune system going into overdrive from receiving help from the medications).

When treated for TB/HIV medications can add up to 30 pills a day each with its own side effects.

Some patients stop because they do not like the side effects.

Unfortunately, patients who delay treatment are more likely to die.


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“The different types of HIV test.” Avert, 19 Mar 2010. Web. 17 May 2010.
http://www.avert.org/testing.htm

“Basic Information about HIV and AIDS.” Centers for Disease Control and Prevention.
Centers for Disease Control and Prevention, 22 Mar 2010. Web.
http://www.cdc.gov/hiv/topics/basic/


Goldman, Bonnie. “HIV Testing 101.” The Complete HIV/AIDS Resource. The Body, 04
Jan 2010. Web. <http://www.thebody.com/content/art49932.html>.


“HIV.” Zegin. Zegin, 17 May 2010. Web.<http://www.zegin.de/cms/index.php?option=com_content &task=view&id=93>.

“HIV/TB Co-Infection Poses Heath Battle on Two Fronts.” Top Ten Humanitarian Crises of 2008. Doctors Without Borders, 2008. Web.
http://www.doctorswithoutborders.org/publications/topten/2008/story.cfm?id=3241.

Johnson, Ramon. "What is HIV-2?" About.com. The New York Times Company, 2010.
Web. <http://gaylife.about.com/od/hivaid1/a/hiv2.htm>.


Prasad, R. "Studying the prevalence of HIV in TB patients." The Hindu: Online edition of India's National Newspaper. The Hindu, 22 Mar 2007. Web.
<http://www.thehindu.com/seta/2007/03/22/stories/2007032200611700.htm>.

Tortora, Gerard, Berdell Funke, and Christine Case. Microbiology. 10th ed. San Francisco, CA: Pearson Education, Inc., 2010. 21, 387, 540-42. Print


“Treating TB, HIV Together Decreases Mortality.” Voice of America. VOANews.com, 31
Oct 2008. Web.
<http://www1.voanews.com/english/news/science-technology/a-13-2008-10-31-voa49.html >.


“Tuberculosis (TB).” CDC. Centers for Disease Control and Prevention, 01 Jun 2009.
Web. <http://www.cdc.gov/tb/topic/basics/default.htm>.


“Tuberculosis and HIV.” Uniting the world against AIDS. UNAIDS. Web. <http://www.unaids.org/en/PolicyAndPractice/HIVTreatment/Coinfection/TB/default.asp>.




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