Last year, Ujjwala Mane, a Malvani resident, tested positive for Human Immunodeficiency Virus (HIV). As per protocol, the health worker advised her to check for tuberculosis (TB). The 28-year-old tested positive for TB too.
Despite being put on the first line of treatment for TB, she showed no recovery and her condition worsened. Further diagnosis showed she had multi-drug-resistant TB (MDR-TB) and had to be taken to Sewree TB Hospital.
“Almost 70% of HIV-TB cases have resistance to drugs,” said SS Kudalkar, project director, Mumbai District Aids Control Society (MDACS). “As per our statistics, 15% to 20% of HIV patients get TB.”
HIV positive patients are extremely vulnerable to TB and pneumonia as the virus affects a patient’s immune system. Although mortality due to TB among HIV patients in the city has gone down from 8 % to 4% in the past four years, a majority of HIV positive patients are contracting MDR-TB or extra-pulmonary TB, activists said.
An adult HIV patient is estimated to get TB three times in his/her lifetime.
“When Mane tested positive for TB and HIV, we enrolled her at the BMC clinic. It took us a month to realise she was not responding to treatment,” said Dr Ashish Bhosale, who runs the Sanmitra Trust, a non-profit that works towards HIV prevention in the slums of Malvani, Malad.
He said it was harder to diagnose symptoms for extra-pulmonary TB among HIV positive patients.
The state government has integrated the TB and HIV intervention programmes wherein a TB patient is tested for HIV and vice versa. The treatments for both diseases are lengthy and may have side effects. Sometimes the medicines may interfere with each other and the line of treatment is altered.
However, the biggest challenge is lack of motivation among HIV-TB patients. “HIV medication continues for life and TB treatment goes on for six to eight months. When it is most crucial to be careful about diet and medication, patients give up and lose hope,” said Bhosale.