In the developing world, tuberculosis (TB) is the leading cause of death among people with HIV infection. Efforts to control the disease are failing in regions where HIV infection is common, particularly in sub-Saharan Africa, partly because advanced HIV disease foils the standard tests used to diagnose tuberculosis. The human immunodeficiency pandemic represents a massive challenge to the control of tuberculosis (TB) at all levels. Tuberculosis is also one of the most causes of morbidity and one of the leading causes of mortality in people living with HIV/Aids (PLWHA). Reports indicate that tuberculosis is a major contributor to disease burden in developing countries where it is exacerbated by the epidemic of HIV infection. About fifteen million of an estimated forty million HIV-infected persons are also infected with Mycobacterium tuberculosis bacteria that bacteria which cause tuberculosis worldwide. It has become increasingly necessary for all people, clinicians and epidemiologists to associate the two disease entities. Nonetheless, care must be taken in all cases, for even if the two diseases are concomitant in many cases, HIV infection is commonly accompanied by other respiratory infections which can easily be confused for tuberculosis. Similarly, tuberculosis can exist in patients by its own rights or will be associated with HIV infection. Although tuberculosis and HIV infection are symbiotically associated, the presence of one of the diseases does not necessarily dictate that the other one is also present. Tuberculosis is a traditional disease which is as old as mankind itself. The advent of HIV infection has increased one tally to traditionally known risk factors to development of tuberculosis – all of which act by decreasing the body immune system thus rendering already existing latent tuberculosis a bonus force to translate itself into actively aggressive, symptomatic as well as fatal form. Rwanda is one of the countries in the Sub-Saharan Africa where both tuberculosis and HIV infection are pandemic. Every month, approximately 500 new cases of any form of tuberculosis are diagnosed in Rwanda – approximately 100 amongst them in Butare, and relatively smaller numbers in Umutara province. The official HIV seroprevalence rate now stands at 5%, putting at risk an estimated 40,000 people, to concomitant development of tuberculosis as their immune systems weaken. The World Health Organisation (WHO) estimates that approximately 36% of identified tuberculosis patients are infected with HIV as well. Unpublished work has it that between 70% to 80% of patients first diagnosed with tuberculosis turn out to be HIV infected as well in University teaching hospitals of Kigali (CHUK). Crude data produced by National Programme for Leprosy and Tuberculosis Control (PNILT) show that up to 44% of all cases registered with sputum smear positive tuberculosis were HIV positive and 66% registered for other forms of tuberculosis were HIV positive during the course of this year. Seroprevalence data of HIV infection in urban and rural settings is available. However, all these data are facility-based, and no information is available regarding the prevalence of either disease in the population. It is therefore very clear that there is a relationship between the two diseases, and we should aim at preventing them altogether. Prevention of tuberculosis has to be focused on identifying infected individuals early — especially those who run the highest risk of developing active disease — and treating them with drugs in a program of directly observed therapy. Tuberculosis therapy prevents the disease in most people in close contact with infected people or who are infected with the tubercle bacilli but who do not have active tuberculosis. The drug is given daily for six to 12 months and strict patient compliance in taking medication is essential to prevent drug-resistant strains from emerging. Health care workers in frequent contact with tuberculosis patients or involved with high-risk procedures such as those that induce coughing should have a skin test every six months. Since we have seen the relationship between the two diseases, it is very important to prevent them both regardless of the cause, and if you happen to have one don’t assume that you have another, though the possibility remains high, what you should do is to go to the hospital as soon as you discover that you are sick. This may not only help you individually to be treated in time but also the community in which you live not to catch the disease from you. Ends
