HIV & TB : THE ODD COUPLE Felipe Gutierrez MD, MPH Infectious Diseases Section Chief Phoenix VA Health System
HIV/TB SYNDEMIC • Urbanization • Poverty • Migration • Increased susceptibility
Reported TB Cases US 1982-2013 30,000 25,000 20,000 15,000 10,000 5,000 0 CDC National TB Surveillance 2013
Increase in Rates of TB US 1985-1992 Urban Areas California New York TR RATE INCREASE 0% 50% 100% Data from Kwan & Ernst.Clin Micro Rev.Apr 2011.351-376
Estimated % HIV/TB Coinfection US 1993-2013 70 60 50 40 30 20 10 0 All Ages Aged 25 - 44 CDC National TB Surveillance 2013
GLOBAL EPIDEMIOLOGY
Afghanistan TB CASES WORLDWIDE Bangladesh Brazil Cambodia China 100% DR of the Congo 90% Ethiopia 80% India 70% Indonesia 60% Kenya Mozambique 50% Myanmar 40% Nigeria 30% Pakistan 20% Phillipines 10% Russian Federation South Africa 0% Thailand Uganda Tanzania Viet Nam Zimbabwe
HIV Prevalence Among New TB Cases WHO Global Tuberculosis Control Report 2014
Global Impact of HIV/TB WHO Global Tuberculosis Control Report 2014
PATH TO SUCCESS • HIV TESTING • ACCESS TO INH • ACCESS TO ART • IDENTIFICATION OF CASES
TREATMENT CHALLENGES FOR THE CLINICIAN
Immune Reconstitution Inflammatory Syndrome (IRIS) • Paradoxical excacerbation of infectious process after initiation of antiretroviral therapy (ART) • Immune mediated process • Timing of ART • Management options
TB-ART DRUG INTERACTIONS • Theoretical vs Practical • Rifamycins – Cytochrome P450 induction Resources • – Local TB Program – CDC 2013 Publication • “Managing Drug Interactions in The Treatment of HIV-Related Tuberculosis” – TB Referal Centers • Heartland National TB Center • National Jewish • Curry International TB Center
QUESTIONS?
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