HIV- TB Cross Referrals

The primary impact of HIV on Tuberculosis is that the risk of developing Tuberculosis (TB) becomes higher in patients with HIV. Overall, HIV-infected persons have approximately 8-times greater risk of TB than persons without HIV infection. Throughout the course of HIV disease, there is an increasing risk of TB. This increased risk is detectable as early as HIV sero-conversion, and the risk of TB almost doubles during the first year after HIV sero-conversion. The risk of TB in HIV-infected persons continues to increase as HIV disease progresses and CD4 cell count decreases. While anti-retroviral treatment can substantially decrease the risk of TB, this risk always remains higher than that in HIV negative individuals. Furthermore, among cured TB survivors with HIV infection, the risk of recurrent TB is also quite high.

TB patients who are HIV positive have higher risk of dying during treatment than TB patients without HIV. HIV positive patients who have TB have higher mortality than HIV positive patients without TB. Even if TB is successfully treated, TB may also accelerate HIV disease progression, increasing the risk of subsequent death or other opportunistic infections in TB survivors. Hence, long term post-TB mortality among PLHA is extremely high. TB is most common opportunistic infection among HIV patients and leading cause of death in HIV patients, Thus NACO with central TB Division introduced, an Intensified TB/HIV Package of Services has been established to provide additional services. These services include:

  1. Routine offer of HIV test to all TB patients.
  2. Decentralized co-trimoxazole prophylaxis for HIV-infected TB patients.
  3. Referral of HIV-infected TB patients to ART Centre for evaluation and initiation of ART.
  4. Expanded recording and reporting on TB-HIV.

Key Programme Performance during April 2014 to Jan 2015

Proportion of referral (Figure 1): Out of 12,31,967 ICTC attendees (general clients), 1,02,730 were referred to RNTCP. Thus, 8.3% were referred to RNTCP for TB diagnosis. Among various districts in Karnataka proportion of clients referred from Udupi (11.7%) district was highest, followed by Koppal (10.8%), Bijapur (12%), Chickaballapur (10.5%), Haveri (10.3%).

Type of TB Diagnosis among ICTC Referred clients and HIV TB Co Infections (figure 3): Out of 6008 cases diagnosed to have TB . 4256 (70.8%) had sputum positive TB, 1199 (19.9%) cases were diagnosed to have sputum negative TB and 553 (9.2) were extra pulmonary TB cases. 15% of sputum TB cases were HIV positive, 26% of Sputum negative cases were HIV positive and 38% of extra-pulmonary TB were found HIV positive.

Number of TB cases diagnosed (figure 2): During 2014-15, out of 6008 TB cases were diagnosed in Karnataka (ICTC to RNTCP). The highest (820) cases were diagnosed in Belgaum district, followed by Bangalore Gulbarga area (406) and lowest in Ramanagar (23) district.

HIV/TB Publication