TB, HIV treatment failures map potholes along American road to care

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In a hospital serving an urban population, more than a third of patients with a confirmed TB diagnosis also had HIV. Of those, nearly three quarters had been diagnosed with the virus that greatly increased their risks of becoming sick from the world’s oldest airborne infection, with a median of six years between a test showing they had HIV, and a test showing they had become sick with tuberculosis. Among those 73 patients already diagnosed with HIV, only 10 were accessing the antiretroviral treatment that protected their immune systems and offered them a defense against TB. Even at the end of their treatment, when 74 patients had accessed antiretroviral medicine, the treatment had been effective enough to suppress the virus in only a little more than half the patients. Three years after they completed the treatment, fewer than a third had maintained continuous treatment for HIV, or suppressed viruses. The high rates HIV/TB co-infection, and low rates of treatment, as well as of viral suppression, compare unfavorably to those of some African countries confronting the highest burden of both diseases.

The hospital where these patients arrived, however, was not in a country where limited resources to counter high burdens of HIV and TB are bolstered by support from the U.S. President’s Emergency Plan for AIDS Relief. Rather, it was in Atlanta, one of many major U.S. cities where a vast division between income levels creates a chasm through which the most vulnerable patients fall. A study reported recently in Open Forum Infectious Diseases describes evidence of the gaps patients encountered along the path to care, that challenged access to their treatment for HIV and TB, and then the success of their treatment, even when their tuberculosis had been cured.

The authors, led by Marcos Schechter, MD, of the Emory School of Medicine, note that their findings reflect both missed opportunities to both diagnose and treat HIV, and to control the spread of TB. While patients’ outcomes reflected challenges that include high rates of homelessness, unemployment and substance abuse, the authors note, they highlight the need for innovative approaches to reach vulnerable populations living in poverty.

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