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Tuberculosis in Africa- An Epidemic Driven By HIV Crisis

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Since the advent of the antibiotic resistance era, Africa has faced the worst epidemic of Tuberculosis. 

For a long time, the Tuberculosis crisis has been driven by Human Immunodeficiency Virus (HIV) that weakens the immunity and healthcare systems.

According to the World Health Organization (WHO), HIV increases the risk of suffering from TB among latently infected patients.  

What is Latent TB Infection?

The phrase latent TB infection refers to an individual infected with TB but does not show any TB signs and symptoms.

These individuals are not sick as the TB germs lie dormant in the body and also cannot spread the infection to others. Such people, however, are at high risk of developing active TB disease when infected with HIV. 

HIV Association with Tuberculosis

For a long time now, HIV/AIDS has been a significant hindrance to successful Tuberculosis control programs in Africa.

It is safe to say that successful TB control depends significantly upon the success rates of controlling HIV transmission. The epidemiological situation reveals evidence of interaction between HIV and Tuberculosis.

The National Tuberculosis Program Activities in Africa emphasizes that the clinical management of TB requires a close examination of risk factors such as HIV/AIDS. 

Tuberculosis is a potentially fatal disease usually caused by Mycobacterium tuberculosis.

The condition mainly affects the human lungs. Mycobacterium tuberculosis are spread from person to person through tiny droplets released into the air via coughs and sneezes.

Once rare in developing countries, tuberculosis infections began increasing in 1985 partly because of the emergence of HIV, the virus that causes AIDS. HIV weakens a person’s immune system hence cannot fight TB pathogens.

In 2005, WHO (World Health Organization) declared TB in Africa as an epidemic that required regional emergency. 

Most control measures used in TB are largely failing today due to HIV. Therefore, understanding the epidemiological relationship between HIV and TB is essential in controlling the spread. 

Africa faces the worst tuberculosis epidemic since the advent of the antibiotic era. Driven by Human Immunodeficiency Virus (HIV) epidemic and compounded by weak health.

In some cases, the population with latent Tuberculosis acquire HIV infection, which increases 100fold the risk of reactivation of Tuberculosis.

In other cases, people with HIV-induced immunosuppression develop new tuberculosis infections and are at extraordinarily high risk for active Tuberculosis.

This cycle of infection and diseases is amplified by the interaction between patients with active Tuberculosis and those with HIV infections in clinics, hospitals, and border communities.

Unfortunately, African countries have been unable to control the spread of HIV related TB due to lack of adequate funding.

The President’s Emergency Plan for AIDS Relief, and  Global Fund to fight AIDS, Tuberculosis and Malaria have donated monetary funds to help address Africa’s health problem

However, most of the money has been earmarked for HIV, with a lesser focus on Tuberculosis.

Throughout Africa, diagnosis for Tuberculosis rests on the microscopic detection of acid-fast bacilli in sputum.

This insensitive technique is particularly ill-suited to the detection of Tuberculosis in HIV negative people have less bacilli in their sputum and less extra pulmonary Tuberculosis compared to HIV-positive patients:

Modern culture and nucleic acid-amplification systems are rarely available.

As a result, many people remain ill and contagious for prolonged periods before the disease is detected, and thousands die without ever having received a diagnosis of Tuberculosis. 

Unfortunately, even with a diagnosis, the average rate of successful treatment is less than 70%, far below the 85% target by WHO.

Relapse and the emergence of drug resistance have become a largely neglected aspect of Africa.

In September 2006, the WHO announced an outbreak of extensively drug-resistant tuberculosis (XDR-TB) recorded in South Africa.

Also, the World Health Organization’s report in 2020 shows that Africa accounts for over 27% of TB cases globally.

This figure has continued to increase since 1990. Additionally, the report reveals that 30% (540 000) of TB-related deaths in the world are in Africa. There are 2.4 million cases of new TB infections in Africa. 

Tuberculosis Risk Factors In Africa

HIV: Since the 1980’s tuberculosis cases have continued to increase due to the spread of HIV which causes AIDS

HIV suppresses one’s immune system, making it difficult for the body to control TB bacteria. As a result, people with HIV are much more likely to get TB and progress from latent to active disease than people who aren’t HIV positive.

Living with HIV Infected Patients: Living in areas densely populated with TB patients increases your chances of contracting TB. Overtime, Africa has been a hotbed of TB. 

Weakened Immune System: If your immune system is strong, your body can fight new pathogens such as the TB bacteria.

However, some medical conditions or drugs may weaken your immunity. They include HIV/AIDS, Kidney conditions, Diabetes, and certain cancers.  

Substance Abuse: Excessive consumption of alcohol can also weaken your immunity system and leave you more vulnerable to Tuberculosis. Tobacco may also increase your chances of getting TB. 

Infection from a TB patient: You risk contracting TB when you come into close contact with TB patients.

Managing Tuberculosis in Africa

Latent TB infection may progress to TB disease among HIV-infected people. Both Latent TB infection and TB disease can be treated and prevented from being fatal.

The first step is to isolate all potentially infected patients in a private room (if possible negative pressure rooms). Medical staff attending to these patients need to wear disposable face masks that help to filter mycobacterium tuberculosis bacteria.

Sputum smears of the isolated patients need to be examined in the lab before being introduced to a drug therapy that may last 2-4 weeks.

Some of the standard 4-drug regimen used to treat TB include Pyrazinamide, isoniazid, rifampin, and streptomycin. 

Conclusion

Community based studies from Africa reveal the epidemiological relationship between HIV and TB infection.

Despite TB control programs such as Direct Observed Therapy treatment (DOT) being well run, they fail to control new TB infections among HIV-infected patients.

If Africa is to shed its heavy load of misery and mortality, it needs to significantly boost investments in research, health care systems, diagnostic laboratories, human resources, and public health services.

 

Written by: Emmanuel J. Osemota

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