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Kumud
World
Journal
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SJIF Impact Factor 5.210
Volume 4, Issue 05, 338-345.
Review Article
ISSN 2278 – 4357
TUBERCULOSIS AND HIV DOUBLE TROUBLE
Hema Madhav, Sitaram and Kumud Bala*
Amity Institute of Biotechnology, Amity University, Noida, UP.
INTRODUCTION
Article Received on
22 Feb 2015,
Revised on 16 March 2015,
Accepted on 06 April 2015
Tuberculosis has been closely linked to HIV since the exposure of
AIDS. Tuberculosis causes infection affecting HIV individuals, and the
most common cause of death in AIDS patients. TB is known to affects
the lungs; however it can also affect the brain, kidneys or other organ
*Correspondence for
systems. TB can cause serious health problems and even death in
Author
serious cases (when no medicine can cure the Mycobacterium
Dr. Kumud Bala
Tuberculosis).Patients with tuberculosis has a weak immune system
Amity Institute of
and hence known as an opportunistic infection.[1] The risk is high
Biotechnology, Amity
University, Noida, UP.
especially for those people who are HIV positive. The host individual
which has the two pathogens, Mycotuberculosis and HIV, enhance
each other; hasten the drop of immunological functions and results in the premature death if
left untreated. TB is known to exacerbate the HIV infection.[2]
TUBERCULOSIS
M. tuberculosis is detected by the innate cells identifying pathogen-associated molecular
outline, by the toll-like receptors and the nucleotide binding oligomerization domain
receptors, which produce a local inflammatory response and due to which it results
macrophages migration in high number and along with the dendritic cells in infected lung
tissue and draining in to the pulmonary lymph nodes which is known as the chemotaxis. This
stimulates the cytokines activation and innate receptor agonists meanwhile the infected
macrophages bring out the bactericidal effect or functions, for instance like the expression of
small GTPases which operate the endosomal trafficking that is Endosomal trafficking is the
cellular process in which the transport of proteins like the integrins, hormone receptors,
growth factor receptors, receptor tyrosine kinases, and lipids, or the
reactive oxygen or
nitrogen intermediates. Dendritic cells can engulf the bacteria by phagocytises in lung tissue,
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migrate to the lymph nodes and initiate the adaptive immune response by priming tyro T
lymphocytes.
The hematopoietic stem cells give lymphoid progenitor which give Dendritic cells , Natural
killer cells and T-cell , B-cell progenitors .T-cell give two types cells that is T-helper cell and
T-cytotoxic cells
T-Helper cells are also known as CD4+ T cells because they express
the CD4 glycoprotein on their surface and cytotoxity cells are also known as CD8+ T cells
since they express the CD8 glycoprotein at their surface[3]. Activation of both CD4+ and
CD8+ T cells is seen in active TB in humans. Cell-mediated immunity is important for control
of M. tuberculosis infection. T- Cells coming to the lung which are infected are used to
oppress infection by producing the interferon gamma (IFN-γ) in response to mycobacterial
antigens presented by macrophages. Sequentially, IFN-γ helps to activate the macrophages to
kill the intracellular bacteria through ROS (reactive oxygen species), and by stir up the
phagolysosome formation.[4]
TUBERCULOSIS TASKFORCES
The Task Force has major stakeholders constituencies belongs to affected communities and
risk groups, UN agencies, human rights and civil society organizations, health and human
rights experts and development partners. Zonal Task Forces (ZTF) facilitate the establishment
of State Task Forces (STF), manage the national as well as the state-level task forces. They
also direct between medical colleges and the State or District TB Centres, and supervise the
actions done by the STF. A National Task Force (NTF) has representatives from Zonal nodal
centres, Welfare (MoH&FW) has been formed. Central TB institutes, WHO and the Central
TB Division, Ministry of Health and Family.
TB and Human Rights Task Force have promoted the Stop TB in Partnership. Their aims
include protecting and promoting human rights, in search of universal access to TB
prevention, diagnosis and treatment. There are mainly 2 purpose of the Task Force that is a
joint WHO, UNAIDS and Stop TB Partnership policy framework for a rights-based approach
to Stop TB so as to advance health, development and effective TB prevention, diagnosis and
treatment and a strategic agenda for 2010-2012 to be taken up and implemented by a wide
range stakeholders within and beyond the TB community. The Central TB Division (CTD),
Government of India conducted various sensitisation seminars and national level workshops,
such as those conducted at the National Tuberculosis Institute (NTI), Bangalore15 and the All
India Institute of Medical Sciences (AIIMS), New Delhi. Now the new medical schools have
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started Using DOTS in their hospitals. Zonal workshops are being organized by the nodal
centres and the respective State TB Offices to establish the Zonal level Task Force in the
respective zones. The Zonal level Task Force members will then facilitate the establishment
of the state level task force comprised five States in the East, eight each in the North-East,
and the North, five in the South and five States in the West zone.
HIV AIDS
Meanwhile the HIV attacks and destroys the T helper lymphocytes that are vital to the
immune system and immune response. HIV when once gets inside your body, the virus is
able to copy itself to infinity and increasing its ability to kill CD4+ T-cells. Shortly, infected
cells outnumber healthy T-cells. If the person’s CD4+ T-cell count goes down, that person is
more exposed to the viruses and infections than a healthy human can resist the exposure to
viruses. The decline in T-cell count is plodding during the initial stages of the infection. After
first few months and years after a person is infected, T-cell counts may remain very near
normal or only slightly decreased.[5] When the T-cell numbers starts to drop dramatically that
patients with HIV begin detecting the additional, aggravation symptoms of the infection.
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Current status of HIV infection in India
HIV pervasiveness database from Ministry of Health and Family Welfare, New Delhi specify
that the occurrence of HIV infection was only 0.36/100. Adult HIV prevalence among males
and females is rough and ready at 0.32% and 0.22% respectively. In 2011, the states, like
Manipur has shown the highest estimated adult HIV prevalence of 1.22%, followed by
Andhra Pradesh (0.75%), Mizoram (0.74%), Nagaland (0.73%), Karnataka (0.52%), Goa
(0.43%) and Maharashtra (0.42%). Along with these states, other states like Orissa, Gujarat,
Tamil Nadu, and Chandigarh have shown estimated adult HIV prevalence greater than
national prevalence (0.27%).HIV-1 infection is common in India than HIV–2 infection.
Manipur has only 0.2% of India’s population but has 8% of India’s total HIV positive cases.
In Manipur HIV were common among the Injecting Drug Users, Female Sex Workers,
homosexuals , heterosexual and children and finally to general population. Between the age
group of 20-30 were found to be affected by HIV. Males, with the least affected comes in the
age group 0–10 with 1.65 % on the other hand the females, from the age group 41–50 with
6.95 % is the lowest. Around 196 cases were reported in 1999 and the cases are still on high
rate due to availability of alternative drugs, heroines, lack of knowledge on HIV. According
to survey study done by National Council of Applied Economic Research on Karnataka, it is
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unambiguous that the major cause of having AIDS are by the sexual contact with their
husbands or by female sex workers. Districts like bagalkot, Belgaum, bidar, Hassan, andya,
udupi which has highest rate of infected patients with HIV in Karnataka.
TB AND HIV CO-EPIDEMIC
Immunocompetent individuals’ means after exposed to an antigen the ability of the body to
produce immune response in a normal amount, when they get infected with M
tuberculosis nearly about 10% risk for developing TB. In contrast, HIV-infected individuals
with latent TB are approximately 20-30 times more likely to develop TB disease than those
who are HIV uninfected, at a rate of 8-10% per year because due to HIV the person’s
immune system is damaged and cannot able to resist the bacterial infection due to the weak
immune system. People with late HIV infection are exposed to various infections and
malignancies that are called opportunistic infections because when the patient’s immune
system gets weak due to HIV took the opportunity to infect that patient with TB. So TB is an
HIV related opportunistic infection.[6]
TB is considered to be as first sign to appear in a HIV infected person. Addressing TB offers
the opportunity for early HIV intervention. While treatment of TB may improve the life
quality of HIV positive people and lengthen their life, but sadly it cannot stop the HIV
infected person from dying of AIDS. This is why access to antiretroviral treatment is also
vitally important.[7] Anti retroviral is the treatment for HIV or AIDS. It is not a cure for such
deadly disease, but it can stop people from becoming ill for many years and extend their life
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to some months. The treatment consists of drugs that have to be taken every day for the rest
of HIV infected person’s life.
Antiretroviral treatment for HIV infection has drugs which resist HIV infection by slowing
down the HIV replication in the patient’s body.[8] The drugs are known to be as:
antiretroviral, anti-HIV drugs and HIV antiviral drugs. If the person is diagnosed with HIV it
is important for that person to have a treatment for TB because, the chances of having TB in
HIV infected person is quiet high and worsen the patient’s health condition moreover to
prevent the further spreading of TB it is vital for the patients to take the TB treatment.[9,10]
This will cure them to some extend and prevent transmission to others. Even in the areas
where antiretroviral drugs are unavailable or inaccessible, it is fundamental that the health
system is able to offer HIV positive people the simple antibiotics needed for DOTS.
AGGRAVATION OF HIV BY TUBERCULOSIS
The main and important target for M. tuberculosis is the alveolar macrophage, in which the
HIV can also affect it.[11,12] The Mycobacteria aggravate HIV replication done in
macrophages and lung cells obtained by bronchoalveolar lavage from co-infected individuals.
The tuberculosis can accelerate both HIV infection and replication within monocyte-derived
macrophages , increase the efficiency of virus transmission from infected monocyte-derived
macrophages to T cells, and regulate the replication of X4 HIV variants by up-regulation of
CXCR4 (Human immunodeficiency virus (HIV) uses 2 distinct chemokine receptors, CCR5
(R5) or CXCR4 (X4), during entry in to the human body ).
During the tuberculosis the M.bacterium tuberculosis activates the tumour necrosis factor
(TNF) which plays an important role for promoting the bacterial growth. Not only the
bacterial growth it also activates the HIV replication. Hence the HIV and M.
tuberculosis triggers TNF release from infected cells, and TNF impede the bacterial growth
while promoting HIV replication.[13]
The HIV replication can also be activated by the lipoarabinomannan (LAM) which is a cell
wall component of the M.tuberculosis, in the cells carrying the provirus. Through the NF-kb
(nuclear factor kappa-light-chain-enhancer of activated B cells) pathway the LAM induces
the TNF and the Interleukin-6 production which activates the transcriptional activation of the
long terminal repeat promoter and also supports the replication of the HIV.[14]
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Step of government for Prevention
A national level Microbicide Expert Group and Microbicide Society of India developed by
ICMR which focus on microbicide, other female controlled options and multiple prevention
technologies. They also do research on contraceptives as well as HIV prevention
technologies. There are several institution developed by ICMR under prevention research
programme. They certify that people with HIV positive and TB suspects should referred to
Revised National Tuberculosis Control Programme Clinic. The TB patients detected by TB
Clinic are passed on to Integrated Counselling and Testing Centre for counselling and testing
the presence of HIV antibody. All HIV positive people with TB infection should receive
Directly Observed Treatment Schedule and Anti-Retroviral Therapy/Treatment on time.
The Co-ordination between the RNTCP and National AIDS Control Programme (NACP) has
established in the six states that is Andhra Pradesh, Karnataka, Maharashtra, Manipur,
Nagaland and Tamil Nadu where, HIV/AIDS problem is widespread. Associating with the
RNTCP for DOTS implementation, medical schools can train the doctors in the making to
actually practice and is taught to them regarding TB control.
SUMMARY
The co- infection of the HIV and TB has a very serious consequence around the world. This
co –infection should be considered as a single subject rather than two different diseases to
prevent further worsening of the HIV-TB. There is an argent need for the extra resources and
new ideas for the treatment, diagnosis and the prevention of this co-infection disease. There
should be a proper linkage between Revised National Tuberculosis Control Programme
Clinic and National AIDS Control Programme.
REFERENCES
1. Hopewell PC, Bloom BR. Tuberculosis and other mycobacterial diseases. In: Murray JF,
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2. Daley CL, Small PM, Schecter GF, et al. An outbreak of tuberculosis with accelerated
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3. Nakata K, Weiden M, Harkin T, Ho D, Rom WN (1995) Low copy number and limited
variability of proviral DNA in alveolar macrophages from HIV-1-infected patients:
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4. Landay AL, Schade SZ, Takefman DM, Kuhns MC, McNamara AL, et al. Detection of
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5. Orenstein JM, Fox C, Wahl SM. Macrophages as a source of HIV during opportunistic
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6. Van Kooyk Y, Appelmelk B, Geijtenbeek TB A fatal attraction: Mycobacterium
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Microbiol, 2004; 53: 391–403.
8. Collins KR, Quinones-Mateu ME, Toossi Z, Arts EJ (2002) Impact of tuberculosis on
HIV-1 replication, diversity, and disease progression. AIDS Rev, 2002; 4: 165–176.
9. Daley CL, Small PM, Schecter GF, et al. An outbreak of tuberculosis with accelerated
progression among persons infected with the human immunodeficiency virus. An analysis
using restriction-fragment-length polymorphisms. N Engl J Med, 1992; 326(4): 231-5.
10. Landay AL, Schade SZ, Takefman DM, Kuhns MC, McNamara AL, et al. Detection of
HIV-1 provirus in bronchoalveolar lavage cells by polymerase chain reaction. J Acquir
Immune Defic Syndr, 1993; 6: 171–175.
11. Orenstein JM, Fox C, Wahl SM Macrophages as a source of HIV during opportunistic
infections. Science, 1997; 276: 1857–1861.
12. Van Kooyk Y, Appelmelk B, Geijtenbeek TB a fatal attraction: Mycobacterium
tuberculosis and HIV-1 target DC-SIGN to escape immune surveillance. Trends Mol Med
2003; 9: 153–159.
13. Briken V, Porcelli SA, Besra GS, Kremer L Mycobacterial lipoarabinomannan and
related lipoglycans: from biogenesis to modulation of the immune response. Mol
Microbiol, 2004; 53: 391–403.
14. Collins KR, Quinones-Mateu ME, Toossi Z, Arts EJ Impact of tuberculosis on HIV-1
replication, diversity, and disease progression. AIDS Rev, 2002; 4: 165–176.
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