1. Indian Scenario HIV Situation TB Situation
Estimated 2.5 million with HIV ( National Adult HIV Prevalence 0.36%)
Prevalence of HIV higher in south
TB Situation
Estimated 400 million infected with TB
1.8 million new TB cases annually
Incidence of TB is higher in north
TB/HIV Co-infection
Estimated 1 million co-infected with TB and HIV
Estimated ~5% of TB patients are HIV positive nationwide ( WHO Global TB Report-2005)

2. Influence of HIV on TB
Lifetime Risk
of TB

4. Common Opportunistic Infections in INDIA Opportunistic Infection
Prevalence
Pulmonary TB
49%
Pneumocystis Carinii Pneumonia 6%
Cryptococcal Meningitis 5%
Cerebral Toxoplasmosis 3%

5. Impact of TB on HIV programme
Increased caseload of active TB among PLWHA
Increased morbidity and mortality from TB among PLWHA
Difficulties with diagnosing TB among PLWHA due to different clinical presentation... (Extra Pulmonary TB)
Increased burden on HIV services

6. Impact of HIV on TB programme
Increased caseload of active TB attributable to HIV
Higher default rates, lower cure rates
More adverse drug reactions
Increased burden on TB services

7. INTENSIFIED TB CASE FINDING AT ICTCS
All ICTC clients should be screened by the ICTC Counsellor for the presence of the symptoms of TB disease.
10 point counseling tool on TB in place
At pre, post, and follow-up Counselling
All TB suspects, irrespective of their HIV status, should be referred to nearest facility providing RNTCP services.
17 February 2019

8. Counselors trained in TB symptom screening
ICF at ICTC
“10-point TB Screening Tool” visible to counselor, with referral list for TB diagnosis In
Counselors trained in TB symptom screening

9. Treatment of TB in HIV-Infected Patients
Anti-TB treatment is the same for HIV-infected persons as it is for HIV-negative TB patients, and all patients should be treated with RNTCP regimens under the DOTS strategy.
All New TB cases known to be HIV positive should be treated with Category I regimen.
The re-treatment cases are to be treated with
Category II regimen.
RNTCP regimens, if supervised properly are
as effective in HIV positive as
in HIV negative patients.

10. TB/HIV CROSS REFERRAL NACP-RNTCP
Treatment should be first administered for TB under the DOTS strategy and if the patient’s clinical condition allows, ART should be started after completion of TB treatment.
All TB patients diagnosed to be HIV positive are to be provided CPT.
17 February 2019

11. TB/HIV
In patients with very low CD4 counts requiring concomitant administration of ART and anti-TB treatment:
- ART regimen should be modified by replacing Nevirapine with Efavirenz.
- On completion of TB treatment, such patients can be switched back to Nevirapine.
17 February 2019