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HIV infection changing TB scenario in Kashmir

Haroon Mirani

Srinagar, September 28, 2007:

Double-Trouble

More than one third of the Human Immuno-deficiency Virus (HIV) positive patients in Indian administered Kashmir suffer from the tuberculosis, according to the health officials, which they say is also changing the Tuberculosis demographics in number of ways.

According to the latest statistics available from Jammu Kashmir State Aids Control Society (JKSACS) there are around 1,185 HIV positive patients in the State. "Of these patients 375 suffer from Tuberculosis," says Imtiyaz Ahmad Parray, State Monitoring and Evaluation Officer at the JKSACS.

Majority of these patients are in Jammu district, which is also by far leading in number of HIV positive patients in the State. Parray said: "We have 365 TB patients on anti-TB drugs at the Chest Disease Hospital in Jammu, whereas 10 patients are undergoing treatment in Sher-e-Kashmir Institute of Medical Sciences in Srinagar."

The increase of TB in HIV positive patients is becoming a worry for the doctors in more than one way.

"Although this is routine in such patients and the occurrence of TB in HIV positive patients is also a leading cause of death in other regions but here it is changing the demographic of TB occurrence," says Dr Manzoor Thakur, Infection Control Officer at SKIMS.

There are 10,268 TB registered patients in Indian administered Kashmir. Out of them 6,178 are in Jammu division and rest of them in the Kashmir division. The government here is already battling with containing this highly contagious disease with not much success. With HIV infection helping in the resurgence of TB infection, matters are becoming worse for health officials.

Dr. Zaffar Amin Shah, associate professor at the SKIMS says that TB is the most opportunistic infection among the HIV patients and Jammu and Kashmir is no exception to it.

Here too 30 to 40 per cent of HIV patients suffer from Tuberculosis.

"The same number of patients also die of the disease," he further added. He said that the Tuberculosis is dormant in the State and HIV is playing a major role in reviving it.

The State officials fear that if the trend continues then the TB ratio of Urban and Rural areas will be drastically changed. "Earlier, what we used to have was that the TB ratio was high in rural areas as compared to the Urban areas," says Dr. Thakur. "But now with HIV initiated TB infection in the urban centres on the boom, the ratio is certainly changing in favour of Urban areas," he further adds.

The ratio of TB is increasing in the urban areas due to the HIV infection, which is primarily prevalent in such places. This paints a grim picture of the entire scenario as according to Dr Thakur, "Some success had been made in containing the TB infection in urban areas, but now all of the efforts are going to be wasted if the situation continues."

The State's traditional rural areas are the hotbed of TB infection. The main cause of TB in Kashmir has been among the tribal population, who live in congested hutments, with one only opening for fresh air. At some places it has been seen that even cattle are herded inside these houses in extreme winters.

"Here TB infection quickly multiplies and situation becomes worse when the residents drink raw milk," says Dr Muzaffar Mirza, Head of Department in Chest Disease Hospital, Srinagar. But now the modern age disease in the shape of AIDS is changing all the infection modes, the doctor opined.

The news is particularly bad for the Jammu district, which is already number one, in terms of the Tuberculosis cases. There are 2,059 registered TB patients in the district and with 365 TB patients coming from HIV positive category, the matter becomes serious.

The treatment for such patients is also different than the regular TB patients.

According to Dr. Shah, the hospital is treating HIV positive patients with TB in two different ways. For those who have AIDS the anti TB drugs are administered in a controlled manner so that the drugs don't react with Anti Retroviral Drugs (ART). "For those where the AIDS has not developed we simply deliver the drugs according to the DOTS programme," says Dr Shah.

Meanwhile, treating HIV positive patients for the TB is also a daunting task for the physicians in the State. In absence of a proper infrastructure for treating HIV patients, the treatment becomes difficult.

Health experts believe that the situation would not have been so bad if there would have been proper facilities for the HIV positive patients. "We don't have care centres or even separate wards for the HIV positive patients here," said a doctor here in SKIMS.

As the majority of patients having HIV infection come from Armed Forces, so there is an added concern regarding the socio-security concerns and building a facility keeping in view such dimensions is a bigger task. Till then the doctors are simply sitting fingers crossed.

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