1. HIV AND TB

2. T UBERCULOSIS Caused by bacterium called Mycobacterium tuberculosis Usually attacks lungs, but can attack any part of the body, such as kidney, spine, brain Can be fatal if not treated

3. T RANSMISSION Through the air: person to person (coughing, sneezing, singing) People nearby inhale bacteria and become infected But not through: Shaking hands Sharing food or drink Bed linens or toilet seats Sharing toothbrushes Kissing

4. 2 TB- RELATED C ONDITIONS Latent TB infection (LTBI) TB Disease

5. L ATENT TB I NFECTION TB bacteria lives in body but doesn’t make person sick No symptoms Positive reaction to tuberculin skin test or special TB blood test Not infectious If bacteria becomes active, person WILL become sick w/TB disease

6. TB D ISEASE TB Bacteria are active (multiplying in body) People w/bacteria may spread it to any people they spend time with Some can have disease soon after becoming infected (within weeks) before immune system can fight the TB bacteria Others get sick years later, when immune system becomes weak for other reasons Risk is higher for those w/weak immune systems (i.e., HIV)

7. C OMPARISON B ETWEEN L ATENT I NFECTION AND TB D ISEASE Latent TB InfectionA Person w/TB Disease Has no symptomsHas symptoms that may include: -a bad cough that lasts 3 wks or more -pain in the chest -coughing up blood or sputum -weakness or fatigue -weight loss -no appetitie -chills -fever -sweating at night Does not feel sickUsually feels sick Can’t spread TB bacteria to others May spread TB bacteria to others

8. C OMPARISON B ETWEEN L ATENT I NFECTION AND TB D ISEASE Latent TB InfectionA Person w/TB Disease Usually has a skin test or blood test result indicating TB infection Has a normal chest x-ray and a negative sputum smear May have an abnormal chest x- ray, or a positive sputum smear or culture Needs treatment for latent TB infection to prevent active TB disease Needs treatment to treat active TB disease

9. T REATMENT For Latent TB Infection Though no TB disease, to prevent development of TB disease in the future, often prescribed treatment. Less bacteria present, so treatment relatively easy INH (isoniazid) Preferred regiment of 9 months Children and people w/HIV may need to take INH for longer

10. T REATMENT For TB Disease Large amount of bacteria present Several drugs can be used, for 6-12 months Drugs must be taken exactly as prescribed Must finish course of treatment or germs that are still alive may become resistant to the drugs TB that is resistant to drugs is harder and more expensive to treat

11. T ESTING & D IAGNOSIS TB Blood Tests aka Interferon-Gamma release assays or IGRAs Measures how the immune system reacts to the bacteria that causes TB Only 1 visit required Results in 24-48 hrs Mantoux tuberculin skin test Small amount of tuberculin injected into skin in lower part of the arm Must return w/in 48-72 hrs to have health care provider observe reaction on arm

12. W HO S HOULD G ET T ESTED Have spent time w/person known or suspected to have active TB disease Have HIV or other problem w/weakened immune system Have symptoms of active TB disease From a country where active TB disease is common (Latin America, Africa, Asia, Eastern Europe, Russia) Live in areas where active TB disease is more common---homeless shelters, migrant farm camp, prison or jail, some nursing homes Inject illegal drugs

13. TB AND HIV C O - INFECTION TB is one of leading causes of death among people infected w/HIV HIV and TB can work together to shorten the life of an infected person A person w/untreated latent TB infection and HIV is much more likely to develop active TB disease than someone w/out HIV Among those w/latent TB infection, HIV infection is the strongest known risk factor for progressing to active TB disease Can be effectively treated

14. LINK BETWEEN STD S AND HIV Individuals infected with STDs are 2-5 Xs more likely than uninfected individuals to acquire HIV infection if they are exposed to the virus through sexual contact If an HIV-infected person is also infected w/another STD, that person is more likely to transmit HIV through sexual contact than another HIV-infected person The presence of other STDs increases the likelihood of both transmitting and acquiring HIV

15. L INK BETWEEN STD S AND HIV Increased Susceptibility Increased Infectiousness

16. STD T REATMENT SLOWS THE SPREAD OF HIV STD treatment reduced an individual’s ability to transmit HIV Herpes can make people more susceptible to HIV infection, and make HIV-infected people more infectious

17. I MPLICATIONS FOR HIV P REVENTION Early detection and treatment of curable STDs should become a major, explicit component of comprehensive HIV prevention programs at national, state, and local levels; In areas where STDs that facilitate HIV transmission are prevalent, screening and treatment programs should be expanded; HIV testing should always be recommended for individuals who are diagnosed with or suspected to have an STD. HIV and STD prevention programs in the United States, together with private and public sector partners, should take joint responsibility for implementing these strategies.