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.
(Source: PlusNews, May 2, 2005)