Clinic tackles urgent need for AIDS/TB treatment

Tuberculosis (TB) is the most frequent opportunistic infection and the leading cause of death for HIV-positive people. The scale of the problem is staggering, with some 12 million people co-infected with HIV and TB, two-thirds of whom live in sub-Saharan Africa. A recently-opened HIV/AIDS and TB research clinic in Durban, South Africa, is one of the few clinics in KwaZulu Natal province which provides combined TB and antiretroviral (ARV) treatment for TB patients co-infected with the virus. KwaZulu Natal has the most tuberculosis cases in the country and has been hard-hit by the HIV/AIDS pandemic. The clinic, which is run by the University of KwaZulu-Natal Centre for the AIDS Programme of Research in South Africa (CAPRISA) and the local municipality, will also conduct research on HIV/AIDS and TB. Researchers became aware of the urgent need for combined HIV/AIDS and TB treatment when data from the Prince Cyril Zulu Communicable Disease Clinic (CDC) - Durban's busiest TB treatment centre - showed that 76 percent of its TB patients were HIV-positive. The CDC treats about 18,000 patients per month. According to director of CAPRISA's AIDS Treatment Programme Dr Kogie Naidoo, treating co-infected patients was even more difficult, as patients' immune functions and CD4-counts decreased more rapidly, opportunistic infections became more complicated and patients could die quicker, she said. In addition, HIV-positive TB patients often experienced multiple side effects due to the toxicity of ARVs and TB drugs, and the high pill-intake necessary to treat the diseases. "TB has fuelled the AIDS pandemic," Naidoo told PlusNews. The newly opened HIV/TB clinic is located next to CDC at Durban's Warwick Triangle, which is one of the main bus and train hubs in and out of the city, making it easily accessible to people travelling from townships and rural areas. As an outpatient facility, the clinic provides supervised treatment, post-test counselling, education and peer support. Patients also receive drug adherence training and support, contraceptive advice and contraceptives as well as treatment of AIDS-related infections. The clinic also helps patients to access social services, such as disability grants. Although the centre was officially opened last month, the CAPRISA staff has been screening 850 HIV-positive TB patients since September 2004. "We started the screening process before the building was fully renovated because the need for a TB/HIV clinic was so great," explained Naidoo. CAPRISA applies the same entry criteria to the ARV rollout as the government, and patients' CD4-counts need to be lower than 200. So far, the clinic has enrolled 150 persons on combined ARV and TB treatment, and a further 200 patients are currently undergoing counselling and other treatment preparation procedures. The clinic's ARV treatment services are sponsored by the US government's President's Emergency Programme Fund for AIDS Relief (PEPFAR), while the ARVs are sponsored by the Global Fund for AIDS, TB and Malaria through the provincial health department. Professor Salim Abdool Karim, head of CAPRISA, said there was "an urgent need for research into the best ways to provide AIDS treatment", adding that it was the clinic's aim to "seek new ways of treating patients with the dual infections of TB and HIV." The research team will be supported by the University of KwaZulu-Natal, which has established a satellite computer link with the CAPRISA TB clinic to give clinic staff and researchers access to the latest research information on HIV/AIDS. "We want to find the optimal point in time to start ARV treatment when a patient is TB co-infected and on TB treatment," added Naidoo. Researchers are still uncertain as to whether the best time to start ARV treatment for TB-infected patients is at the beginning, the peak or the end of the TB treatment phase, she further explained.