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HIV AIDS FAQ's

What is tuberculosis?

Tuberculosis (TB) is an infectious disease, which is caused by Mycobacterium tuberculosis. Every year three million people lose their lives due to TB. In India alone every year half a million people die of TB, i.e. one thousand people every day and one person every minute succumb to TB.

Most commonly TB affects the lungs, although it can involve any organ of the human body.

How does TB spread from one person to another?

TB spreads through the air. Every time a person with active TB coughs, sneezes or speaks, TB bacteria spread in the atmosphere through his/her breath. Other person living in such an atmosphere (i.e. family members, friends or colleagues) can inhale these bacteria into their lungs. Once inside the human body these bacteria start multiplying in number. They can spread to any organ of the body via blood. TB of the lungs or larynx can spread from one person to another whereas TB of other organs, such as brain, kidneys or vertebral column, is non-infectious.

What is Latent TB Infection or LTBI?

Most people are capable of controlling TB bacteria after they have gained an entry into their bodies. The bacteria usually become inactive, but they continue to live and are capable of causing active TB in a person years later. This is known as Latent TB infection or LTBI. Persons with LTBI are without any symptoms and cannot transmit TB to others.

Most people with LTBI may continue to lead a healthy life. The immunity of some persons may get weakened due to poor nutrition or while they are suffering from diseases like diabetes, cancer or AIDS. In such persons TB bacteria present in their body can activate themselves and produce active TB disease.

LTBI can be diagnosed by a simple test known as a tuberculin skin test (in which a fluid is injected under the skin). It can be treated by regularly taking one medicine daily for six to nine months and the risk of getting active TB disease in future can be averted.  

What are the symptoms of TB?

The symptoms of TB of the lungs are:

Cough, which may be two or three weeks old. Initially this cough may be dry but later it becomes productive. Sometimes the phlegm may be mixed with blood.

Fever, which is accompanied by rigors and chills. It tends to return to normal along with cold sweats, especially at night.

Pain in the chest and difficulty breathing.

Loss of weight and appetite.

What is BCG vaccine?

In certain countries of the world that have a high TB burden (e.g. India) children are given vaccination after birth for prevention of TB. This vaccine may not provide complete protection against the disease but can help ward off certain complications of TB. 

If a person has already been vaccinated with BCG he may demonstrate a positive reaction to the tuberculin skin test.

A positive tuberculin skin test implies that either the person has received prior BCG vaccination or has LTBI.

If a person has spent some time in a high TB burden country, has lived with a patient who has active TB, or has lived in a home for shelter-less people, jails or de-addiction centers, a positive tuberculin skin test may point towards LTBI.

If I am HIV-positive, what do I need to do?

HIV knocks down the immune system of a person slowly. In such a situation LTBI may convert itself into active TB disease. All HIV- positive persons shall undergo tuberculin skin testing. In case of a positive reaction, treatment for LTBI needs to be started. If there are signs of active disease in an HIV-positive person, a complete course of a WHO-recommended treatment regimen must be given.

Please remember that it is possible to cure TB in an HIV-positive person.

How is TB diagnosed? 

In a country such as India, which accounts for one third of the global TB burden and every second adult is infected with TB bacteria; examination of sputum is a simple and cost-effective method for diagnosing TB. The sputum of a patient is examined thrice and if need be, a chest x-ray can also be done.

Some countries that have fewer TB patients use a tuberculin skin test to diagnose LTBI.  In this test a health worker injects a small amount of fluid under the skin. The health worker reexamines the site of injection after forty-eight to seventy-two hours. These countries also use chest x-ray, sputum examination and culture for confirming the diagnosis of active TB disease.

Is there a cure for TB?

The good news is that both active TB disease and LTBI can be treated and cured.

A person with LTBI has to take INH everyday for a period of six to nine months.

Patients with active TB disease have to complete a WHO-recommended regimen (comprising of four to five drugs) for a period of six to nine months.

What will be the result if I do not take my medicines regularly?

It takes some time to eliminate TB bacteria from the body. Anti-TB drugs need a period of six to nine months to accomplish it. Within a few weeks of starting anti-TB treatment, a patient notices an improvement in his condition. Remember, this is a very crucial juncture! The TB bacteria are still active in the patient’s body and treatment must be continued to achieve cure.

A disruption in treatment can result in worsening of disease and it can return with a vengeance. It is possible that medicines used initially may become ineffective. Newer and more costly drugs may be required for treatment at this point. A prolonged treatment course may become necessary. It is essential that a patient continues with treatment till the health worker advises.

How can a patient remember to take medicines regularly?

The World Health Organization has developed a strategy for control of TB. This is called Directly Observed Treatment, Short-course or DOTS. In areas covered by the DOTS programme, a health worker or a volunteer watches a TB patient swallow the tablets in his/her presence. There are certain other benefits of DOTS as well. A health worker ensures that the patient receives a regular supply of medicines. These medicines need to be taken only thrice or twice in a week. The worker also keeps close watch on the patient’s progress and looks for any side effects of anti-TB medicines.

If a patient is not living in an area served by DOTS, the following tips may be helpful:

Take medicines at an appointed time everyday.

Ask a family member or a friend to remind you everyday (people have tried reminding through telephone and even used SMS services of cell phones).

Put a mark through the day on your calendar each day after taking your medicines.

What can a patient do to help control or limit the spread of TB?

The most important factor is that a patient with active TB disease takes regular treatment and completes the full course. During the period of treatment, sputum examination is done at fixed intervals and an X-ray examination chest may also be needed.

If a TB patient is being treated at home, then a few precautions need to be observed to prevent transmission of TB other family members.

Whenever a TB patient coughs, sneezes or speaks he/she should cover his mouth and nose with a tissue paper. The tissue paper should be disposed carefully in a dustbin and patient should wash his/her hands with soap afterwards,

Patient should maintain a distance from family members and friends.

Within a period of few weeks of start of treatment the bacteria disappear from sputum and risk of transmission of TB is markedly reduced.

What are the side effects of medicines used for treating TB?

Most of the drugs used for treating TB are safe and have minimal side effects.

Due to certain drugs used for treating TB, the color of a patient’s urine may turn red.

If a patient notices yellowish color in eyes or skin, unusual itching, weakness or tiredness, the health worker or treating physician must be contacted immediately. A patient should not discontinue the treatment on his own because the decision to change or discontinue a particular medicine rests with treating physician.

If a patient is also taking birth control pills, she should talk to her health worker about other methods of preventing a pregnancy because one of the primary TB medicines can reduce the effect of birth control pills.

What is Multi Drug Resistant TB (MDR-TB)?

When a patient does not take the treatment regularly, then one or more medicines used in treatment may lose their effect against TB bacteria. This is known as MDR-TB. In such a situation newer and more costly drugs are required for treatment. There is also a risk of spread of this drug resistant TB to others.

We are pleased to inform you that Hindi translation of these FAQs is available in print form from Health and Development Initiative-India. If you wish to place an order please contact, Director at: dinesh@healthinitiative.org

(Health and Development Initiative-India expresses its sincere thanks to Ms. Betty Gore, RN MSN CIC, of SC Dept of Health & Environmental Control, Columbia, United States of America for her help in preparing these FAQs and making them relevant to an international audience.

We are also sincerely thankful to Mrs. Raj Kumari Prabhakar O.T., Mrs. Nonia Dhaliwal M.A. M.Phil (Hindi) and Mr. Satish Srivastva of Dainik Jagran  (a reputed Hindi national newspaper) for facilitating preparation of Hindi translation of these FAQs.)