adminCatherine Murombedzi H I V Column
DIABETES mellitus (DM) and tuberculosis (TB) have a link. Many people have not really taken time to see that this co-infection is on the increase. In 2013 in Africa 4 percent of the DM burden was in this continent. In the same
continent 29 percent of the TB burden was noted. (WHO-Global TB control 2014).
Sub-Saharan Africa bears the brunt of the HIV/TB infection and still experiences new infections of HIV. Globally, there is a bigger number of people who are diabetic, but do not know that they are and yet there are many thousands more that are not yet diagnosed. A proportion that is 50 percent remains undiagnosed and there is a challenge in that some of those diagnosed with TB have not been notified. (WHO Global Report 2014).
According to Diabetes Atlas International Diabetes Federation, WHO reported that in 2013, 382 million people had DM and this figure could rise to 552 million in 2030. The risk of one acquiring TB increased in people with DM. Other causes that suppress the immune system e.g. HIV and Aids increased the risk to getting TB again. Alcohol and substance abuse were noted as increasing risk to active TB infection.
The issue that DM increases risk of TB has been recognised in ages back during the Roman times. Previously there was little interest which has changed in the last 10 years. DM increases the risk of TB by two to three times. Patients with DM have impaired immunity and poor lung defences against multi-drug resistance TB which makes them prone to the risk.
The world anticipates that there will be an 80 percent decline in TB incidence in 2030 as compared to 2015, but this can’t be achieved if DM diagnoses and treatment is not accelerated. In Zimbabwe we still have deaths due to TB. Noted also is recurrent TB infection. There is need to be collaborative framework for care and control of TB and diabetes as there is collaborative framework for TB and HIV co-infection.
Patients with DM and TB are treated simultaneously. Harare City Department Director of Health Services, Dr Prosper Chonzi, said they were coping well in handling the co-infection.
“We treat diabetes at the same time that we commence a patient on TB medication if they are found to have the co-infection. We have managed to have both under control and we have a framework policy in our clinics on managing such patients,” said Dr Prosper Chonzi.
“TB is treated for six months with a cocktail of medications, but we mainly use isoniazad and rifampicin. After six months, a patient is screened to check if any TB remains and if so the treatment is extended until no trace of TB is found. Patients must note that they are cleared of TB, but have to continue taking medication for diabetes because it is life-long treatment,” he added.
“Diabetes medication is life-long, but you find patients may get tired of taking the pills. This is pill fatigue and it usually occurs when they are feeling much better or could have developed side effects from taking the medication,” he said.
People who have been detected to have TB have recoiled into a shell at times and have found it difficult to disclose that they are on treatment. This stigma could be due to lack of understanding of TB transmission.
“TB is highly infectious when one is not on treatment and it is during this time that one does not even know that they have TB that they are infectious. Usually with correct taking of anti TB medicines one is no longer infectious 72 hours after commencing TB treatment if this is not multi drug resistance TB. So there is no fear of one on treatment. People on TB treatment have been stigmatised because of this lack of information,” said Dr Charles Sandy who heads the AIDS and TB unit in the Ministry of Health and Child Care.
Early identification of TB and treatment results in manageable outcomes. We find that TB is now presenting with HIV, diabetes and even hypertension. So since HIV patients are screened for TB all TB patients have to be screened for DM as the co-infection may cause havoc if left unchecked.
Random blood glucose tests are carried out mostly at private institutions. There is no cohort analysis and recording of DM in public institutions. Treating patients with DM and TB co-infection has to be high on the health agenda as leaving it too late may result in what we experienced with TB and HIV in the 90s to mid 2000.
“In the late 90s it was noted that the HIV-TB co-infection was an emergency and lives were lost to the co-infection,” said Dr Sandy.
“As health personnel, we are alert and have taken to have diabetes and TB treatment to be offered simultaneously. It will not get to levels that TB/HIV co-infection did as we now have the know-how and effective medicines,” he said.
Online Reporter