Can she be on ARV,anti-TB drugs at the same time
Nov 28, 2012
Normally when people who are HIV positive are found to have TB, whether it is in the lungs or any other organ, they are advised to start taking ARVs regardless of their CD4 counts.
Q:Dear Doctor,
My sister has had a swelling in the neck for two months, which is painless. When it was cut and examined, it was found to be caused by tuberculosis. She was advised to test for HIV and she is HIV positive.
When they did her CD4 count, it was found to be 380 cells/ml. The doctor has put her on anti-TB drugs and advised her to start taking ARVs. However, she is not sick and we are wondering whether she has to be on ARVs and anti-TB drugs at the same time considering the tablets are so many.
Annette
ADear Annette,
Normally when people who are HIV positive are found to have TB, whether it is in the lungs or any other organ, they are advised to start taking ARVs regardless of their CD4 counts.
This is because people living with HIV (PLHIV) who have TB of the lungs are said to be in stage three of HIV infection,
While those with TB outside of the lungs (extra pulmonary TB) are in stage four.
Many people in stage three and four HIV infection have AIDS. So, all PLHIV in stage three and four should be on ARVs regardless of their CD4 counts.
However, if your sister cannot tolerate taking anti TB drugs together with ARVs because of the number of pills involved, she should be put on anti-TB drugs for two months during which time ARVs could be withheld.
After the two months of intensive treatment with four drugs: (Ethambutol, Pyrazinamide, Rifampicin and Isoniazid); they are reduced to two drugs (Rifampicin and Isoniazid).
These are continued for at least six months. ARVs can then be introduced during this continuation phase. It is important that she is encouraged to adhere to both ARVs and anti TB drugs even when she does not feel sick, because poor adherence causes resistance to both anti TB drugs and ARVs.
This would be dangerous not only to her, but to the whole community, as other people could come in contact with such drug resistant HIV and TB.
Both HIV and TB are best avoided through prevention, but people infected by the two diseases should be identified as soon as possible even if they are not sick, so that care and treatment are instituted early to avoid deaths and onward transmission.
********************************
Why do people with high CD4 count take ARVs?
QDear doctor,
I have heard people say that if we start people who have AIDS on ARVs when they have high CD4 counts we would reduce new infections, but I would like to know how this is possible. I thought immediately one is infected he or she starts spreading the virus to others. Please explain.
Daniel
ADear Daniel,
All methods of HIV prevention are used because they reduce the risk of transmitting or acquiring the virus. None of them can be said to be 100% effective on its own.
That is why we now recommend combination prevention strategies instead of pushing one as the silver bullet that can stop HIV transmission and acquisition.
However, you need to know that not all PLHIV have AIDS, which occurs when one’s immune system is destroyed and he or she succumbs to multiple opportunistic infections that characterise this stage of HIV infection.
Most people with high CD4 counts do not have AIDS and they look healthy. However, because they have a high viral load, they can easily transmit HIV to others through unprotected sex and from mother to child.
That is why we have continued having high numbers of new infections annually, due to many people who have HIV but because they do not know it, they continue with normal activities including having un protected sex and producing children.