MANY unnecessary deaths could be averted if patients infected with both HIV and tuberculosis (TB) were diagnosed and treated earlier, a study at Edenvale hospital in KwaZulu-Natal has found. The study provided evidence of the devastating toll TB was taking on people infected with HIV who do not have adequate access to healthcare, said Ted Cohen, assistant professor at Harvard Medical School and lead author of the study, published this week in the journal PLoS Medicine. Prof Cohen and his colleagues conducted autopsies among 240 adults who died at Edenvale hospital in a 10-month period between 2008 and last year, in a bid to understand the extent to which TB contributed to deaths in people who were infected with HIV. They found 94% of the patients were HIV-positive and half of them were being treated with TB drugs when they died. But many of the patients who were on TB treatment were still carrying active bacteria, suggesting they had been diagnosed too late to alter the course of the infection. Prof Cohen said the mean time between admission and death was less than a week, adding that most of them were getting the right drugs, so if they had been diagnosed earlier their lives would not have been lost. The researchers found 17% of the patients with TB had undetected multidrug-resistant strains, and suggested this may be the case with many more people infected with HIV. TB infection in people who have HIV is often harder to diagnose. The most widely used TB tests look for tuberculosis bacteria cultured from sputum samples, a process that can take weeks. In patients who have HIV, sputum samples often give a false negative for TB - either because there is too little bacteria in the sputum to be detected, or the disease has taken hold outside the lungs. SA had introduced a policy that says anyone infected with HIV should routinely be tested for TB and vice versa, but in practice testing levels were "quite low", said Paula Akugizibwe, an activist with the AIDS and Rights Alliance for Southern Africa, "because of lack of infrastructure and resources”.

Tamar Kahn: Business Day, 24 June 2010