TB ravages HIV/Aids patients: WHO

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GENEVA: The World Health Organisation warned on Tuesday that progress in tackling tuberculosis was far too slow, as it doubled its estimate of the ravages the disease is causing among HIV/Aids patients.
Some 9.27 million people contracted TB in 2007, an increase of about 30,000 over the previous year mainly in line with population growth, according to the WHO’s annual report on tuberculosis control.
They included some 1.4 million people with HIV/Aids, compared to an estimated 600,000 in 2006 reported last year.
More than one death in four — 456,000 of the 1.75 million tuberculosis deaths recorded in 2007 — is now thought to involve an HIV/Aids patient.
‘These findings point to an urgent need to find, prevent and treat tuberculosis in people living with HIV and to test for HIV in all patients with TB in order to provide prevention, treatment and care,’ said WHO Director General Margaret Chan in a statement.
However, the report reiterated that there were severe shortcomings in tackling tuberculosis and coordinated care for both diseases largely due to feeble heath care in the developing countries that are the hardest hit.
Just one in seven HIV patients get vital preventive treatment for TB, said WHO HIV/Aids director Kevin De Cock.
Overall, more than one third of tuberculosis cases are not diagnosed, leaving many out of reach of treatment and, crucially, increasing the risk of spreading the contagious disease, according to the UN health agency.
While the overall rate of TB infection fell in three years to 139 cases per 100,000 people, the improvement was too slow, said Mario Raviglione, the agency’s anti-tuberculosis chief.
’We are talking about less than one per cent per year, which will get us to potentially eliminate TB in a very distant future: we are talking centuries if not millenia in a way,’ he told journalists. The growth in the estimated impact on HIV/Aids patients was largely down to better data and understanding.
’The revision is illustrative of the fact that people living with HIV have a risk of developing tuberculosis that’s 20 times greater than HIV negative people,’ said De Cock.
Despite progress in testing TB patients for HIV in Africa, the combination of poor diagnosis, rising drug resistance and the evidence of the impact on highly vulnerable HIV/Aids patients have heightened alarm among health experts.
Detection of the highly contagious disease has stagnated after a sharp improvement nine years ago, while the impact drug resistant strains of the TB bacteria has grown to infect an estimated 500,000 people.
Just one per cent of them receive treatment and 150,000 of them die, according to the WHO, which regards resistance as the ‘achilles heel’ of the anti-TB drive.
‘The scale-up of interventions to deal with multidrug TB is not at the pace we would like to see and is far from the targets that have been established,’ Raviglione said.
Furthermore, 10 per cent of them were almost incurable extra-resistant strains (XDR-TB) that are now found in 55 countries.
The WHO is gathering the 27 countries that account for 85 per cent of multidrug resistant cases of tuberculosis — including India, China, Russia, South Africa and Bangladesh - for a meeting in Beijing on April 1.
‘You could be in middle of a drug resistant TB epidemic and not even know about it,’ De Cock pointed out.

Pulmonary infections

Pneumocystis pneumonia (originally known as Pneumocystis carinii pneumonia, and still abbreviated as PCP, which now stands for Pneumocystis pneumonia) is relatively rare in healthy, immunocompetent people, but common among HIV-infected individuals. It is caused by Pneumocystis jirovecii.
Before the advent of effective diagnosis, treatment and routine prophylaxis in Western countries, it was a common immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count is less than 200 cells per µL of blood.[16]
Tuberculosis (TB) is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, is easily treatable once identified, may occur in early-stage HIV disease, and is preventable with drug therapy. However, multidrug resistance is a potentially serious problem.
Even though its incidence has declined because of the use of directly observed therapy and other improved practices in Western countries, this is not the case in developing countries where HIV is most prevalent. In early-stage HIV infection (CD4 count >300 cells per µL), TB typically presents as a pulmonary disease. In advanced HIV infection, TB often presents atypically with extrapulmonary (systemic) disease a common feature. Symptoms are usually constitutional and are not localized to one particular site, often affecting bone marrow, bone, urinary and gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system.[17]

Tumors and malignancies

Patients with HIV infection have substantially increased incidence of several cancers. This is primarily due to co-infection with an oncogenic DNA virus, especially Epstein-Barr virus (EBV), Kaposi's sarcoma-associated herpesvirus (KSHV), and human papillomavirus (HPV).[27][28]
Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance of this tumor in young homosexual men in 1981 was one of the first signals of the AIDS epidemic. Caused by a gammaherpes virus called Kaposi's sarcoma-associated herpes virus (KSHV), it often appears as purplish nodules on the skin, but can affect other organs, especially the mouth, gastrointestinal tract, and lungs.
High-grade B cell lymphomas such as Burkitt's lymphoma, Burkitt's-like lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary central nervous system lymphoma present more often in HIV-infected patients. These particular cancers often foreshadow a poor prognosis. In some cases these lymphomas are AIDS-defining. Epstein-Barr virus (EBV) or KSHV cause many of these lymphomas.
Cervical cancer in HIV-infected women is considered AIDS-defining. It is caused by human papillomavirus (HPV).[29]
In addition to the AIDS-defining tumors listed above, HIV-infected patients are at increased risk of certain other tumors, notably Hodgkin's disease and anal and rectal carcinomas. Malignancies that affect AIDS patients such as Kaposi's sarcoma and AIDS-related Non-Hodgkin lymphoma often arise in the gastrointestinal tract. [30]
However, the incidence of many common tumors, such as breast cancer or colon cancer, does not increase in HIV-infected patients. In areas where HAART is extensively used to treat AIDS, the incidence of many AIDS-related malignancies has decreased, but at the same time malignant cancers overall have become the most common cause of death of HIV-infected patients.[31]

History

Main article: Origin of AIDS
AIDS was first reported June 5, 1981, when the U.S. Centers for Disease Control (CDC) recorded a cluster of Pneumocystis carinii pneumonia (now still classified as PCP but known to be caused by Pneumocystis jirovecii) in five homosexual men in Los Angeles.[138] In the beginning, the CDC did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus.[70][71] They also used Kaposi's Sarcoma and Opportunistic Infections, the name by which a task force had been set up in 1981.[139] In the general press, the term GRID, which stood for Gay-related immune deficiency, had been coined.[140] The CDC, in search of a name, and looking at the infected communities coined “the 4H disease,” as it seemed to single out Haitians, homosexuals, hemophiliacs, and heroin users.[141] However, after determining that AIDS was not isolated to the homosexual community,[139] the term GRID became misleading and AIDS was introduced at a meeting in July 1982.[142] By September 1982 the CDC started using the name AIDS, and properly defined the illness.[143]
A more controversial theory known as the OPV AIDS hypothesis suggests that the AIDS epidemic was inadvertently started in the late 1950s in the Belgian Congo by Hilary Koprowski's research into a poliomyelitis vaccine.[144][145] According to scientific consensus, this scenario is not supported by the available evidence.[146][147][148]
A recent study states that HIV probably moved from Africa to Haiti and then entered the United States around 1969.[149

Can AIDS be treated?

Antiretroviral treatment can prolong the time between HIV infection and the onset of AIDS. Modern combination therapy is highly effective and someone with HIV who is taking treatment could live for the rest of their life without developing AIDS.

An AIDS diagnosis does not necessarily equate to a death sentence. Many people can still benefit from starting antiretroviral therapy even once they have developed an AIDS-defining illness. Better treatment and prevention for opportunistic infections have also helped to improve the quality and length of life for those diagnosed with AIDS.

Treating some opportunistic infections is easier than others. Infections such as herpes zoster and candidiasis of the mouth, throat or vagina, can be managed effectively in most environments. On the other hand, more complex infections such as toxoplasmosis, need advanced medical equipment and infrastructure, which are lacking in many resource-poor areas.

It is also important that treatment is provided for AIDS-related pain, which is experienced by almost all people in the very advanced stages of HIV infection.

hiv aids India and China

India harbours two quite separate HIV epidemics. In the south, where heterosexual sex is the main transmission route, prevention projects have largely focussed on sex workers and their clients. This approach is credited with reducing HIV prevalence among all young women in southern states from 1.7% in 2000 to 1.1% in 2004.⁴⁰ By contrast, the main driver of HIV in the northeast is injecting drug use, and responses there have been lacking. As in many parts of Asia, men who have sex with men have also been neglected.

Neighbouring China has a much lower HIV prevalence than India, but some parts of the country are much worse affected than others. In central China, tens of thousands of people became infected during the 1990s when they sold their blood to commercial agencies. Authorities eventually reacted by enforcing tighter regulations, and the blood donation system causes far fewer new infections than before. In 2005, around 94.5% of blood came from volunteer donors, compared to just 22% in 1998. Today, most HIV transmission takes place during drug use or unprotected sex.⁴¹

China has traditionally taken a zero tolerance approach to drugs; the police are used to arresting drug users and sending them to compulsory rehabilitation centres. Recently, however, that attitude has started to change, and schemes providing methadone treatment and clean needles have been set up in several provinces. Some regions have also altered their approach to sex workers by introducing a 100 per cent condom use programme, peer education and treatment for sexually transmitted infections.⁴² On a national scale, the government has introduced routine HIV testing of people thought to be at high risk of infection, including drug users, sex workers, former blood donors and patients at sexual health clinics. This has led to many more people being diagnosed, though some experts have voiced concern that some people may be pressured not to refuse testing.⁴³ Overall, China’s response to HIV is improving, but coverage is still too patchy to have a substantial impact.

AIDS Lifecycle Includes Protest in Closing Ceremonies

AIDS/LifeCycle
Leaders of L.A. Gay & Lesbian Center and San Francisco AIDS Foundation, with 2,150 Cyclists, Decry Proposed Cuts in HIV Funding at Conclusion of AIDS/LifeCycle 8

Participants in 545-mile trek from San Francisco to Los Angeles Raise $10.5 million

LOS ANGELES, June 6, 2009—Cheered by fans, friends, family and local residents, about 2,150 bicyclists streamed into Los Angeles today for the conclusion of the eighth annual AIDS/LifeCycle, a seven-day, 545-mile journey from San Francisco that raised $10.5 million for the HIV/AIDS-related services of the L.A. Gay & Lesbian Center and the San Francisco AIDS Foundation.

At the closing ceremony at the Veteran's Administration Center in West Los Angeles, the riders and 500 volunteer roadies from 41 states and 14 nations celebrated their heroic accomplishment. Led by San Francisco AIDS Foundation Chief Executive Officer Mark Cloutier and L.A. Gay & Lesbian Center Chief Executive Officer Lorri L. Jean, the participants decried the massive cuts in HIV/AIDS-related services in the governor's proposed budget and agreed to carry their message to communities across California.

"Elected leaders in our state government are poised to make massive cuts in essential health and human services, including $80 million for vitally needed HIV/AIDS services," said Jean. "We cannot allow them to balance the state budget at the expense of so many lives! We call on the elected leaders of our state to exhibit the same amazing compassion and courage that you all have shown over the past week, to appreciate the dire consequences of their proposals, and to fund the HIV/AIDS services that literally save lives."

Holding their helmets or hands over their faces during the ceremony, the cyclists and roadies represented the scores of lives that will be lost if legislators approve the proposed $80 million reduction in HIV/AIDS-related services—a roster of cuts which would deny life-saving drugs to low-income Californians, eliminate HIV testing, counseling and education programs, and turn the clock back on years of progress in fighting the AIDS epidemic.

"The proposed budget will put the most vulnerable Californians at risk and jeopardize the health and safety of communities we've long rallied to protect," said Cloutier. "The heroes of AIDS/LifeCycle 8 stand in unanimous opposition to potentially disastrous elimination of vital HIV/AIDS services."

The AIDS/LifeCycle participants ranged in age from 18 to 78 and included novice cyclists as well as event veterans, all of whom raised at least $3,000. They traveled through eight California counties, occasionally outnumbering the populations of the communities through which they rode. In many towns along the route, local residents applauded and displayed signs welcoming and encouraging the riders.

At the closing ceremony, actor Leslie Jordan, best known for his role as Beverly Leslie on the hit series Will & Grace, led a Riderless Cycle procession to commemorate all those lost to AIDS.

AIDS/LifeCycle's presenting sponsors were Shopoff Properties Trust, FedEx Corporation and Gilead Sciences.

Photographs from the AIDS/LifeCycle Closing Ceremony will be available for downloading at 8 p.m. (PDT) on Saturday, June 6 at http://www.aidslifecycle.org/press/.

Event photos and cyclists' journals can be viewed at http://experience.aidslifecycle.org. Additional information can be found on the AIDS/LifeCycle website at www.aidslifecycle.org/press-room/.