ARVs reduce deaths due to TB-HIV co-infection

The arrival of antiretroviral (ARV) drugs in the rebel-held north of Cote d'Ivoire is having a dramatic impact on tuberculosis-related deaths. "Antiretroviral medications have considerably reduced the death rate of the patients in our care. The situation was catastrophic," said Dr Francis Coulibaly, head of the pneumonia department at the University Hospital Centre in Bouaké, headquarters of the New Forces rebel movement. "About 80 percent of tuberculosis patients at the hospital are HIV positive," explained Dr Coulibaly. "Before we started to care for HIV-positive patients, my department was a place where people were being left to die." The hospital received its first ARVs from the national AIDS programme in April 2005, three years after the start of the conflict that split the country in two. ARVs are also extending the lives of TB patients in the New Forces-held town of Danané, on the western border with Liberia. The hospital, run by medical charity Médecins sans Frontières (MSF), also began receiving anti-AIDS drugs last year. "It is clear that tuberculosis is becoming a serious problem," said Howard Moore, an MSF doctor in Danané, where more than half the hospital patients are believed to be HIV positive. "If we are to succeed in curing them, we will have to treat the two infections, HIV and TB, at the same time." In Cote d'Ivoire TB has become the main cause of death for HIV-positive patients; more than 70,000 new cases were reported in 2005 by the National Programme to Fight Tuberculosis. TB and HIV co-infection speeds up the progress of both diseases and considerably shortens the survival of people living with HIV/AIDS. HIV infection is the most potent risk factor in converting latent TB into active TB. Treating patients with both infections is complicated. TB patients are usually required to take a course of powerful antibiotics for six months under a labour-intensive directly observed treatment strategy (DOTS) that requires health workers to be present when the pills are taken. The bulk of health workers in the north of Cote d'Ivoire fled when the conflict began, adding to the difficulties faced by Coulibaly and his remaining staff. "It is difficult when there is a war ... but Cote d'Ivoire must use the DOT strategy to ensure that the patient does not become TB-drug resistant because he does not take his medication regularly." Patients have to visit the university hospital in Bouaké every Wednesday, swallow their TB medication in front of the nurses, and collect their pills for the week - a system Coulibaly acknowledges is not foolproof. "The DOT strategy needs many health workers, and we have problems with regard to the treatment being followed. Patients throw away the tablets, refuse to take them, or just cannot swallow them due to the state of their health," said Dr Louis Kakudji, medical coordinator of the MSF team at the regional hospital in the western town of Man. MSF in Danané and Man are using mobile medical teams for patient follow-up to try to reduce treatment interruption, one of the chief causes of multidrug-resistant TB, which has become a major public health problem. "In this establishment, where HIV is the main reason for hospitalising adults, 48 percent of the patients had abandoned their TB treatment," said Kakudji. DOTS normally achieves a cure rate of up to 95 percent after six months of treatment, but some forms of drug-resistant TB require extensive chemotherapy for up to two years. //This report is part of a series by IRIN's HIV/AIDS service PlusNews looking at treatment and care in communities in crisis. Visit: www.plusnews.org