TB, HIV patients must not be ignored

The world is grappling with Covid-19 and science is working overtime to find quicker testing platforms, curative therapies and/or a vaccine to halt Sars-Cov 2, the causative virus.

Preventative measures have been put in place to break the chain and slow down transmission.

How will this pandemic affect the many vulnerable populations? Elderly people and those with co-morbidities such as hypertension, diabetes and heart conditions are at a higher risk of more severe disease if infected. This is attributed to lack of a robust enough immune system.

People who have HIV/Aids and TB have reduced immunity, especially if not on treatment. A majority of these are in Africa. What does Covid-19 mean for them? TB is still the world’s leading infectious disease killer.

A majority of TB infections are pulmonary, that is, affecting the lungs, just like the viral pneumonia observed in Covid-19. At least two symptoms of both infections are similar – fever and coughing. Additionally, close contact and cough droplets are aids of transmission of the infecting agents, Sars-Cov-2 and Mycobacterium TB.

Although there is little data on the effect of pulmonary TB on Covid-19 susceptibility or vice versa, an observational report out of Wuhan, China, suggested that TB infection (whether active or latent) would likely increase the risk of Sars-Cov-2 infection and severity of subsequent disease.

With damage left on the lung even after full recovery, the long-term consequence of TB on the lungs might affect the severity of Covid-19. Even more concerning is any individual with undiagnosed TB would likely be at higher risk for acquiring Sars-Cov-2. Testing is thus very important.

There is no evidence of a co-infection of HIV and Sars-Cov-2 and what its consequence would be. However, it is known that HIV infection increases susceptibility to TB and it is not farfetched to hypothesise that uncontrolled HIV might increase risk of developing Covid-19.

HIV patients being immune compromised might show less symptoms at initial stages of a Sars-Cov-2 infection, and this would make case detection of Covid-19 even more challenging.

Nonetheless, people who are on antiretroviral therapy and whose HIV viral loads are suppressed would be in a better position to fight Sars-Cov- 2 than those who are not.

So, what does this mean?

The importance of compliance of treatment regimens for HIV and TB and such at risk groups is crucial. HIV and TB programmes need to continue unabated. These groups of people need specific protection. This raises yet another concerning issue.

The health capabilities of even the most advanced and best resourced countries in the world have been stretched to the limits by Covid-19. What would an epidemic at levels as seen in some of these countries mean for less resourced nations such as ours?

Kenya has seen significant strides in reducing the number of new HIV infections. With the Covid-19 crisis, efforts should be made to maintain these critical HIV and TB services to ensure a steady supply of drugs and that other follow-ups in the management of these patients are conducted as required.

In the same breath, HIV and TB patients should adhere to their recommended treatment regimens while following strictly the procedures outlined to protect against Covid-19.

Lucy Mwangi is an infectious disease researcher at UoN