Temporary Disabled. :) please Go back Tuberculosis www.fgks.org » Address: [go: up one dir, main page] Include Form Remove Scripts Accept Cookies Show Images Show Referer Rotate13 Base64 Strip Meta Strip Title Session Cookies International HIV & AIDS charity DonateFundraising About Us Our Partners Help & Advice Contact Us Facebook Linked in Twitter Newsletter Copyright © AVERT skip to menu Tuberculosis back to top Quick TB Facts: 2011 8.7 million people developed TB worldwide in 2011 13 percent of people with TB were living with HIV 3.2 million people with HIV screened for TB Less than half of people identified as having TB and HIV started antiretrovirals 1.4 million people died of TB - 430,000 were HIV-associated TB deaths back to top What is tuberculosis? Tuberculosis, sometimes referred to as TB, is a disease caused by an organism called mycobacterium tuberculosis. The mycobacterium tuberculosis bacteria can attack any part of the body, but most commonly attack the lungs. back to top How is tuberculosis transmitted? Symptoms of Active Pulmonary TB Current cough Fever Weight loss Night sweats A person can have active or inactive (sometimes called latent) tuberculosis. Active tuberculosis or TB disease means the bacteria are active in the body and the immune system is unable to stop them from causing illness. People with active tuberculosis in their lungs (pulmonary TB) can pass the bacteria on to anyone they come into close contact with. When a person with active tuberculosis coughs, sneezes or spits, people nearby may breathe in the tuberculosis bacteria and become infected.1 Some people have active tuberculosis in other parts of their body, besides the lungs; for example, the lymph nodes, spine or brain. People can also be infected with tuberculosis bacteria that are not active in their body. If a person has inactive (or latent) tuberculosis, it means their body has been able to successfully fight the TB bacteria and stop them from causing illness. People who have latent tuberculosis do not feel sick, do not have symptoms and cannot pass tuberculosis on to other people. In some people tuberculosis bacteria remain inactive for a lifetime without becoming active. But in some other people the inactive tuberculosis may become active tuberculosis if the person's immune system becomes weakened - for example by HIV. back to top Tuberculosis (TB) and people with HIV Tuberculosis (Mycobacterium tuberculosis bacillus) HIV weakens the immune system, at which point people who have latent TB develop active TB and become unwell. People who are co-infected with both HIV and latent TB have an up to 50 times greater risk of developing active tuberculosis disease and becoming infectious compared to people not infected with HIV. People with advanced HIV infection are vulnerable to a wide range of infections and malignancies that are called 'opportunistic infections' because they take advantage of the opportunity offered by a weakened immune system. Tuberculosis is an HIV-related opportunistic infection. A person that has both HIV and active tuberculosis has an AIDS defining illness. The HIV/AIDS epidemic is reviving an old problem in well resourced countries and greatly worsening the existing problem of tuberculosis in resource poor countries. There are several important associations between the epidemics of HIV and tuberculosis: Tuberculosis is harder to diagnose in HIV-positive people Tuberculosis progresses faster in HIV-infected people Tuberculosis in HIV-positive people is more likely to be fatal if undiagnosed or left untreated Tuberculosis occurs earlier in the course of HIV-infection than other opportunistic infections back to top TB prevention for people with HIV Preventative therapy The World Health Organisation (WHO) recommends the following approach to preventing TB infection in people living with HIV. Using the antibiotic, Isoniazid, latent TB present inside the body can be killed, preventing active TB from developing. It is important that people are tested for active TB before taking preventative Isoniazid therapy. This is because taking Isoniazid when you have active TB can lead to resistance to this drug in the future. All children and adults living with HIV should receive Isoniazid preventive therapy. This includes pregnant women and people taking antiretroviral therapy. This should be taken for between 6 and 36 months. In places where HIV and TB prevalence is high, life-long preventative therapy should be provided. Regular screening People with HIV should be screened for TB regularly, ideally at every health clinic visit. Screening of pregnant women with HIV, for active TB should be part of maternal HIV services. People living with HIV in crowded settings, such as, prisons, centres for refugees or internally displaced persons, should receive screening and Isoniazid preventative therapy. TB Vaccine There is a vaccine against tuberculosis called BCG, but the vaccine is now very old (it was first used in the 1920s), and tests have found it to be very variable in its ability to protect people from infection in modern settings. When it does provide protection form tuberuclosis, this generally only lasts for around 15 years. The BCG can also cause false-positive readings on the tuberculin skin test. If given to HIV positive adults or children with very weak immune systems, the BCG can occasionally cause disseminated BCG disease, which is often fatal. back to top Getting Tested for TB Xpert MTB/RIF Rapid Test This test detects active TB and rifampicin drug-resistance in sputum samples. A modern test that gives results within 2 hours – including among people with HIV, who may otherwise receive a negative sputum smear microscopy result. WHO recommend using this test as the initial diagnostic test for people suspected of having multi-drug resistant TB or HIV-related TB. A positive rapid TB test result should be confirmed with a TB culture test.2 3 Sputum smear microscopy This test requires a sputum sample being taken and it being analysed under a microscope. It can take a day for a sputum smear microscopy result. TB present in people with HIV may not be detected via a sputum sample. Chest x-ray People with symptoms of active TB, who have received a negative sputum smear test should have a chest x-ray. Active TB can cause scarring to the lungs, which shows up on a chest X-ray. Diagnosing TB in HIV-positive people in this way can be difficult due to scarring from previous TB episodes or due to other HIV-related causes. TB culture test This test involves growing a sputum sample in a laboratory – this can take a few weeks. People who have the symptoms of TB, but a negative sputum smear microscopy should have a TB culture test. This can also be used to test for suspected drug-resistant TB. Tuberculin skin test This test finds out if a person has been exposed to TB bacteria by detecting antibodies to TB. This will be present in anyone who has TB (latent and active), had TB in the past. back to top Active tuberculosis: Treatment and cure As part of the DOTS strategy, a patient with tuberculosis takes daily doses of pills during supervised treatment Active tuberculosis disease can almost always be cured with a combination of antibiotics. The variety of treatments and drug options depend on the country you are in. A proper combination of anti-tuberculosis drugs provides both prevention and cure. Effective treatment quickly makes the person with tuberculosis non-contagious and therefore prevents further spread of tuberculosis. Even in settings where antiretroviral drugs are unavailable or inaccessible, it is crucial that the health system is able to offer HIV positive people the simple drugs needed for DOTS. Achieving a cure for TB takes about six to eight months of daily treatment. Several drugs are needed to treat active tuberculosis. Taking several drugs does a better job of killing all of the bacteria and is more likely to prevent them from becoming resistant to the drugs. The four first-line drugs used to treat drug-susceptible TB are: Isoniazid Rifampicin (Rifadin, Rimactane) Ethambutol (Myambutol) Pyrazinamide For some people it can be difficult to take drugs for both tuberculosis and HIV at the same time. Some anti-HIV drugs can also interact with some tuberculosis drugs making the treatment more difficult. It is important that the tuberculosis treatment is taken regularly and exactly as the health care provider has advised. If the drugs are not taken regularly, the bacteria can become resistant to the drugs and this can be dangerous. Multi-drug resistant TB (MDR-TB) is when the bacteria has become resistant to Isoniazid and Rifampicin, the two most powerful anti-TB drugs. It is more difficult to treat MDR-TB as well as being considerably more expensive.4 To ensure thorough treatment, it is often recommended that the patient takes his or her pills in the presence of someone who can supervise the therapy. This approach is called DOTS (directly observed treatment, short course). DOTS cures tuberculosis in 95% of cases, and a six-month supply of DOTS costs as little as $10 per person in some parts of the world. back to top What are multi-drug resistant TB (MDR-TB) and extreme drug resistant TB (XDR-TB)? When a strain of tuberculosis bacteria is resistant to two or more 'first-line' antibiotic drugs it is called multi-drug resistant TB or MDR-TB. When it is resistant to three or more 'second-line' antibiotics as well, it is classed as extreme drug resistant tuberculosis, or XDR-TB. Drug resistance usually arises when tuberculosis patients do not or cannot take their medicine as prescribed, and drug-resistant mutations of the bacteria are allowed to replicate. People can also catch MDR and XDR-TB from others. MDR-TB is a serious problem and is very difficult to treat. In normal treatment (sometimes referred to as 'first-line' treatment) for tuberculosis, patients take the drugs isoniazid and rifampicin (the most effective tuberculosis drug available) plus other drugs for around six to eight months. If a person is resistant to isoniazid and rifampicin however, they are said to have MDR-TB, and will need to change to a regime containing newer and often less widely-available 'second-line' drugs. Treatment with second-line drugs can take a very long time, and is usually far more expensive than standard DOTS therapy because most of the drugs are still under patent. XDR-TB is even more serious. If someone has XDR-TB, it means they are not only resistant to isoniazid and rifampicin, but to three or more of the six available second-line drugs too. This can make it virtually impossible to formulate an effective treatment regime for them. Many people with XDR-TB will die before it is even realised that they have the extreme resistant strain. In 2006, 53 people in the province of KwaZulu Natal in South Africa were identified as having XDR-TB. Of these people, 52 died within 25 days of tuberculosis being diagnosed. The majority were HIV positive. However, progress is being made to better understand XDR-TB globally. In South Africa, by late 2006 an estimated 2000 - 3000 people with XDR-TB, and a similar or higher number of people with MDR-TB were on treatment with second-line drugs.5 This report highlights that a robust national treatment programme that includes facilities for infection control, improved laboratory and clinical capacity and more efficient diagnostic technologies can be effective, not only for treatment but also to prevent untreatable patients from transmitting XDR-TB within hospitals and their communities. Although HIV infection does not of itself increase the chance of drug resistance occurring, both MDR-TB and XDR-TB are very serious threats to HIV positive people, whose weakened immune systems render them unlikely to fight off tuberculosis naturally (often the only hope for those with a resistant strain). back to top The global response to tuberculosis (TB) The discovery of antibiotic drugs that kill bacteria was a turning point in tuberculosis control. In well resourced countries, tuberculosis was previously treated with a special diet and bed rest, usually in a sanatorium. In the late 1950s it was found that this was unnecessary and that tuberculosis could be cured with well-supervised antibiotic treatment at home.6 The World Health Organisation (WHO) first implemented the DOTS strategy in 1995; a strategy nearly all countries have adopted. Between 1995 and 2011, more than 51 million patients have been treated using the DOTS approach and up to 20 million lives have been saved.7 Nevertheless, improved diagnostic methods for detecting tuberculosis are desperately required, as is a more effective vaccine against the disease. New and more potent drugs are also needed to help simplify and shorten treatment, and fight multi-drug resistant TB (MDR-TB). The emergence of MDR-, and especially XDR-TB, threatens tuberculosis control efforts across the globe, including those in well resourced countries. In 2011 there were an estimated 310,000 cases of MDR-TB among notified TB patients with pulmonary TB.8 Almost 60% of MDR-TB cases worldwide are estimated to occur in India, China and Russia. For many years, tuberculosis remained relatively overlooked on the global scale, but the importance of addressing MDR and XDR-TB, and other issues, is now being recognised internationally. In 2006, the Stop TB Partnership launched "The Global Plan to Stop TB", an initiative that aims to achieve the Millenium Development Goal (MDG) of halving the death rates and prevalence of tuberculosis worldwide by 2015. If successful, the plan will save over 14 million lives, and will pave the way for the ultimate goal of eradicating tuberculosis by 2050.9 On 21 March, 2013, one thousand days before the MDG's expire, African health leaders and international organisations launched a new initiative aimed at accelerating progress towards the target. Termed the 'Swaziland Statement', U.S.$120 million worth of investments are part of the package to eradicate deaths to tuberculosis.10 email print tweet more Where Next? AVERT.org has more about: Opportunistic infections AIDS around the world HIV testing Back to top Sign up to our Newsletter Donate Sources back to top Treatment Action Campaign (2007) 'TB in Our Lives: A book of information sheets for people living with TB, support groups and clinics' - 2007 Tuberculosis Country Profiles - 2013 WHO (2012) "Global Tuberculosis Report 2012" - 2012 WHO (2013) "TB diagnostics and laboratory strengthening" - 2013 Target Tuberculosis (2013) 'TB Fact Sheets" - 2013 References back to top CDC TB Fact Sheets - Latent TB Infection vs. TB Disease, CDC WHO (2013) 'TUBERCULOSIS DIAGNOSTICS: Xpert MTB/RIF Test' WHO (2011) 'Automated Real-time Nucleic Acid Amplification Technology for Rapid and Simultaneous Detection of Tuberculosis and Rifampicin Resistance: Xpert MTB/RIF System Policy Statement' WHO (2012) "Global Tuberculosis Report 2012" Dheda K. and Migliori G.B. (2012, February) 'The global rise of extensively drug-resistant tuberculosis: is the time to bring back sanatoria now overdue?', Lancet 379(9817) History of TB, Global Tuberculosis Institute WHO (2012) "Global Tuberculosis Report 2012" WHO (2012) "Global Tuberculosis Report 2012" The Global Plan to Stop TB 2011-21015, Stop TB Partnership, 2010 UNAIDS (2013, 20 March) 'UNAIDS and other health organizations support new TB and HIV initiative in Africa' english español back to content home pageHIV & AIDS Topics Treatment & CareEpidemicGlobal EpidemicAIDS & HIV Around the WorldAIDS : What is AIDS? 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Tuberculosis, sometimes referred to as TB, is a disease caused by an organism called mycobacterium tuberculosis. The mycobacterium tuberculosis bacteria can attack any part of the body, but most commonly attack the lungs.
Symptoms of Active Pulmonary TB
A person can have active or inactive (sometimes called latent) tuberculosis.
Active tuberculosis or TB disease means the bacteria are active in the body and the immune system is unable to stop them from causing illness. People with active tuberculosis in their lungs (pulmonary TB) can pass the bacteria on to anyone they come into close contact with. When a person with active tuberculosis coughs, sneezes or spits, people nearby may breathe in the tuberculosis bacteria and become infected.1 Some people have active tuberculosis in other parts of their body, besides the lungs; for example, the lymph nodes, spine or brain.
People can also be infected with tuberculosis bacteria that are not active in their body. If a person has inactive (or latent) tuberculosis, it means their body has been able to successfully fight the TB bacteria and stop them from causing illness. People who have latent tuberculosis do not feel sick, do not have symptoms and cannot pass tuberculosis on to other people. In some people tuberculosis bacteria remain inactive for a lifetime without becoming active. But in some other people the inactive tuberculosis may become active tuberculosis if the person's immune system becomes weakened - for example by HIV.
HIV weakens the immune system, at which point people who have latent TB develop active TB and become unwell. People who are co-infected with both HIV and latent TB have an up to 50 times greater risk of developing active tuberculosis disease and becoming infectious compared to people not infected with HIV.
People with advanced HIV infection are vulnerable to a wide range of infections and malignancies that are called 'opportunistic infections' because they take advantage of the opportunity offered by a weakened immune system. Tuberculosis is an HIV-related opportunistic infection. A person that has both HIV and active tuberculosis has an AIDS defining illness.
The HIV/AIDS epidemic is reviving an old problem in well resourced countries and greatly worsening the existing problem of tuberculosis in resource poor countries. There are several important associations between the epidemics of HIV and tuberculosis:
The World Health Organisation (WHO) recommends the following approach to preventing TB infection in people living with HIV.
Using the antibiotic, Isoniazid, latent TB present inside the body can be killed, preventing active TB from developing. It is important that people are tested for active TB before taking preventative Isoniazid therapy. This is because taking Isoniazid when you have active TB can lead to resistance to this drug in the future.
People with HIV should be screened for TB regularly, ideally at every health clinic visit.
There is a vaccine against tuberculosis called BCG, but the vaccine is now very old (it was first used in the 1920s), and tests have found it to be very variable in its ability to protect people from infection in modern settings. When it does provide protection form tuberuclosis, this generally only lasts for around 15 years. The BCG can also cause false-positive readings on the tuberculin skin test. If given to HIV positive adults or children with very weak immune systems, the BCG can occasionally cause disseminated BCG disease, which is often fatal.
This test detects active TB and rifampicin drug-resistance in sputum samples. A modern test that gives results within 2 hours – including among people with HIV, who may otherwise receive a negative sputum smear microscopy result. WHO recommend using this test as the initial diagnostic test for people suspected of having multi-drug resistant TB or HIV-related TB. A positive rapid TB test result should be confirmed with a TB culture test.2 3
This test requires a sputum sample being taken and it being analysed under a microscope. It can take a day for a sputum smear microscopy result. TB present in people with HIV may not be detected via a sputum sample.
People with symptoms of active TB, who have received a negative sputum smear test should have a chest x-ray. Active TB can cause scarring to the lungs, which shows up on a chest X-ray. Diagnosing TB in HIV-positive people in this way can be difficult due to scarring from previous TB episodes or due to other HIV-related causes.
This test involves growing a sputum sample in a laboratory – this can take a few weeks. People who have the symptoms of TB, but a negative sputum smear microscopy should have a TB culture test. This can also be used to test for suspected drug-resistant TB.
This test finds out if a person has been exposed to TB bacteria by detecting antibodies to TB. This will be present in anyone who has TB (latent and active), had TB in the past.
Active tuberculosis disease can almost always be cured with a combination of antibiotics. The variety of treatments and drug options depend on the country you are in. A proper combination of anti-tuberculosis drugs provides both prevention and cure. Effective treatment quickly makes the person with tuberculosis non-contagious and therefore prevents further spread of tuberculosis. Even in settings where antiretroviral drugs are unavailable or inaccessible, it is crucial that the health system is able to offer HIV positive people the simple drugs needed for DOTS. Achieving a cure for TB takes about six to eight months of daily treatment.
Several drugs are needed to treat active tuberculosis. Taking several drugs does a better job of killing all of the bacteria and is more likely to prevent them from becoming resistant to the drugs. The four first-line drugs used to treat drug-susceptible TB are:
For some people it can be difficult to take drugs for both tuberculosis and HIV at the same time. Some anti-HIV drugs can also interact with some tuberculosis drugs making the treatment more difficult. It is important that the tuberculosis treatment is taken regularly and exactly as the health care provider has advised. If the drugs are not taken regularly, the bacteria can become resistant to the drugs and this can be dangerous. Multi-drug resistant TB (MDR-TB) is when the bacteria has become resistant to Isoniazid and Rifampicin, the two most powerful anti-TB drugs. It is more difficult to treat MDR-TB as well as being considerably more expensive.4
To ensure thorough treatment, it is often recommended that the patient takes his or her pills in the presence of someone who can supervise the therapy. This approach is called DOTS (directly observed treatment, short course). DOTS cures tuberculosis in 95% of cases, and a six-month supply of DOTS costs as little as $10 per person in some parts of the world.
When a strain of tuberculosis bacteria is resistant to two or more 'first-line' antibiotic drugs it is called multi-drug resistant TB or MDR-TB. When it is resistant to three or more 'second-line' antibiotics as well, it is classed as extreme drug resistant tuberculosis, or XDR-TB. Drug resistance usually arises when tuberculosis patients do not or cannot take their medicine as prescribed, and drug-resistant mutations of the bacteria are allowed to replicate. People can also catch MDR and XDR-TB from others.
MDR-TB is a serious problem and is very difficult to treat. In normal treatment (sometimes referred to as 'first-line' treatment) for tuberculosis, patients take the drugs isoniazid and rifampicin (the most effective tuberculosis drug available) plus other drugs for around six to eight months. If a person is resistant to isoniazid and rifampicin however, they are said to have MDR-TB, and will need to change to a regime containing newer and often less widely-available 'second-line' drugs. Treatment with second-line drugs can take a very long time, and is usually far more expensive than standard DOTS therapy because most of the drugs are still under patent.
XDR-TB is even more serious. If someone has XDR-TB, it means they are not only resistant to isoniazid and rifampicin, but to three or more of the six available second-line drugs too. This can make it virtually impossible to formulate an effective treatment regime for them. Many people with XDR-TB will die before it is even realised that they have the extreme resistant strain.
In 2006, 53 people in the province of KwaZulu Natal in South Africa were identified as having XDR-TB. Of these people, 52 died within 25 days of tuberculosis being diagnosed. The majority were HIV positive. However, progress is being made to better understand XDR-TB globally. In South Africa, by late 2006 an estimated 2000 - 3000 people with XDR-TB, and a similar or higher number of people with MDR-TB were on treatment with second-line drugs.5 This report highlights that a robust national treatment programme that includes facilities for infection control, improved laboratory and clinical capacity and more efficient diagnostic technologies can be effective, not only for treatment but also to prevent untreatable patients from transmitting XDR-TB within hospitals and their communities.
Although HIV infection does not of itself increase the chance of drug resistance occurring, both MDR-TB and XDR-TB are very serious threats to HIV positive people, whose weakened immune systems render them unlikely to fight off tuberculosis naturally (often the only hope for those with a resistant strain).
The discovery of antibiotic drugs that kill bacteria was a turning point in tuberculosis control. In well resourced countries, tuberculosis was previously treated with a special diet and bed rest, usually in a sanatorium. In the late 1950s it was found that this was unnecessary and that tuberculosis could be cured with well-supervised antibiotic treatment at home.6
The World Health Organisation (WHO) first implemented the DOTS strategy in 1995; a strategy nearly all countries have adopted. Between 1995 and 2011, more than 51 million patients have been treated using the DOTS approach and up to 20 million lives have been saved.7 Nevertheless, improved diagnostic methods for detecting tuberculosis are desperately required, as is a more effective vaccine against the disease. New and more potent drugs are also needed to help simplify and shorten treatment, and fight multi-drug resistant TB (MDR-TB). The emergence of MDR-, and especially XDR-TB, threatens tuberculosis control efforts across the globe, including those in well resourced countries. In 2011 there were an estimated 310,000 cases of MDR-TB among notified TB patients with pulmonary TB.8 Almost 60% of MDR-TB cases worldwide are estimated to occur in India, China and Russia.
For many years, tuberculosis remained relatively overlooked on the global scale, but the importance of addressing MDR and XDR-TB, and other issues, is now being recognised internationally. In 2006, the Stop TB Partnership launched "The Global Plan to Stop TB", an initiative that aims to achieve the Millenium Development Goal (MDG) of halving the death rates and prevalence of tuberculosis worldwide by 2015. If successful, the plan will save over 14 million lives, and will pave the way for the ultimate goal of eradicating tuberculosis by 2050.9 On 21 March, 2013, one thousand days before the MDG's expire, African health leaders and international organisations launched a new initiative aimed at accelerating progress towards the target. Termed the 'Swaziland Statement', U.S.$120 million worth of investments are part of the package to eradicate deaths to tuberculosis.10
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Giving young people a platform to share their thoughts and experiences raises awareness among their peers and gives an invaluable insight into the needs of this high-risk group. More than 2,400 young people are newly infected with HIV every day, accounting for 40% of new adult infections.
Involving youth in the HIV response is key to lowering new HIV infections among the next generation and the role of technology in doing this is now clearer than ever.
A sneak preview of results from an AVERT survey, due to be released on International Youth Day 2013 - 12 August, show that most young people prefer to get their sexual health and HIV/AIDS information online or via mobile, as it's quicker, confidential and cheap. But not all youth are the same, we've found regional variations in the type of technology young people prefer - with 67% of respondents from Africa using mobile phones for health information, compared to just 31% in Europe.
To commemorate International Youth Day 2013 - 12 August, share your experiences with others by sending AVERT your story. Raise HIV awareness among youth, check out the hints, tips and quizzes below and share them with your friends.