The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ...

HIV AND TUBERCULOSIS 7
without consistent clinical alleviation. Further,
the use of cyclosporin, despite its obvious
potential hazards, and intravenous gammaglobulin
has also been tried. Further trials of
antibody preparations may be expected 19
The Effect of HIV Infection on Tuberculosis
Programmes
Besides the possible increase in the number of
tuberculosis patients, to receive services,
important qualitative changes in the tuberculosis
services can be anticipated in the HIV/AIDS era.
The new problems to be tackled include the
following 10 :
1. HIV positive persons are frequently
tuberculin negative, lowering the sensitivity of this
tool.
2.. The clinical and radiographic pictures of
tuberculosis are different from what is normally
seen.
3. There are reports of more frequent
relapses with the use of conventional
chemotherapy and CDC has made different
recommendations for effective treatment.
4. The concern about the use of BCG,
following reports of severe local reactions and
possible dissemination has led to a modification
in the WHO EPI recommendation favouring its
exclusion in symptomatic HIV infected children.
5. The transmission of HIV may occur
among TB patients through the use of
inadequately sterilized syringes for Streptomycin
injections. The joint WHO/IUATLD working
group on HIV infection and tuberculosis 20 has
recommended that when sterility of needles and
syringes cannot be ensured, an entirely oral
regimen should be used. The working group has
further recommended that in countries where the
national TB programme strategies include
chemoprophylaxis, dual infection with HIV and
M. tuberculosis should be considered as an
indication for chemoprophylaxis.
So far as India is concerned, pessimism on
account of AIDS may not be warranted as the
seroprevalence rate even in high risk groups is
comparatively low. Nevertheless, vigilance and
prompt action by clinicians and programme
planners is called for.
Acknowledgement
We are grateful to Director, JIPMER and
Director, Health and Family Welfare Services,
Government of Pondicherry for permission to
publish this paper. Shri Ram Mohan's assistance
in getting the computer print outs is also
acknowledged.
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