Makes it mandatory for all HIV-TB retreatment cases to undergo culture tests.
State officials have found a one-size-fits-all formula for curbing the TB epidemic. In the face of the dual challenges of curbing rising number of multi-drug resistant tuberculosis (MDR-TB) and high mortality rates in patients with HIV-TB co-infection, they have decided to nip the problem in the bud through early detection.
In January after the scare of total drug resistant TB (TDR-TB) struck Mumbai, it was classified a Category C [see box] city. The criteria are now being extended to the entire state; the complete implementation is expected by December 2012.
Dr Pradeep Gaikwad, state joint director for tuberculosis and leprosy said, “The guidelines have been revised to tackle late detection of MDR-TB. Until now, we first tried basic course treatment for HIV-TB person and if it didn’t work, we tested for MDR-TB to start advanced drug regimen. But from now on, every HIV-TB patient will undergo MDR-TB tests.”
Gaikwad explained that about 17% of HIV-TB co-infection cases tested positive for MDR-TB. “Earlier we would lose six months because MDR-TB wasn’t suspected until the first line drugs failed.
Now we are eliminating that time gap in detection. Now all HIV-TB patients would be started on anti-retroviral treatment (ART) irrespective of CD4 (type of white blood cell which are part of immune system) counts. Earlier only patients with low CD4 counts were started on ART but now early treatment would bring down mortality rate,” added Gaikwad.
“We carry out basic sputum test to determine TB. However results are not entirely reliable. If a patient comes back for treatment after taking incomplete treatment for few months, the bacteria could become suppressed. However on culture tests, it shows they have MDR-TB. Hence we have revised criteria and all retreatment cases will undergo advanced tests,” said Gaikwad.
Dr Jalil Parker, chest physician at Mumbai’s Lilavati hospital said, “HIV patients have very high chance to land up with MDR TB. Until now, HIV TB patient continues with basic TB drugs without knowing if they are working. Early MDR tests would make a big
difference.”
Dr S Gaikwad, head of TB department at Sassoon General Hospital said the modification will help bring down the mortality rate in HIV patients.
Dr Ashok Mahasur, chest physician, PD Hinduja hospital, “HIV positive patients are extremely vulnerable to TB and pneumonia as the virus affects a patient’s immune system. It will help in saving lives of HIV-TB co-infected patients.”
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