AIDS

1
AIDS

• At present about 33 million are infected with HIV
• Life expectancies are falling dramatically, e.g.
  Zimbabwe 65 to 39 years now
• 90 of infections in developing countries esp
  Africa and Asia
• 5 of HIV patients progress to AIDS each year

2
Multi Drug Resistant Tuberculosis

• Requires TB culture facilities to assess
  situation
• Rapid Increase in ex-Soviet countries
• Prison focus, mainly males
• Drugs not very effective, expensive though off
  patent, toxic and difficult to use
• Outcomes generally poor without full effective
  treatment 5-7 drugs

3
Fixed Dose Combination Treatments

• 2 Drug FDCs now cheaper than components
• WHO advocating 4 drug FDCs for all intensive
  phase therapy
• Problems with bio-availability of rifampicin can
  be solved
• Requires bioavailability QA testing

4
Strategic Choices for TB

• Drug Choices
• Drop thiacetazone
• Change to FDCs
• Introduce DOTS as a high priority
• Monitor actively for MDRTB (Culture 2 month
  positives)
• Decentralize diagnosis and treatment within
  centrally defined policies
• Treat HIVve patients actively

5
Controversies in TB Programs

• Is there a place for chemoprophylaxis for TB in
  HIV positive patients?
• Should streptomycin be a second line drug?
• What should a poor country do about MDRTB cases
• What should be done with MDRTB cases who are
  resistant to all drugs?
• Is the free TB treatment policy viable in very
  poor countries?
• What role should the private sector play in TB
  control?