Menus Subscribe Search

Teaming with Technology to Fight TB and HIV

• November 24, 2010 • 10:00 AM

Tuberculosis and HIV are both high-profile global health scourges, but surprisingly little focus has been paid on treating them when they team up.

Tuberculosis — already infecting the global population about one new case a second — is considered one of the most dangerous opportunistic infections attacking people with HIV.

The STOP TB Partnership reports that TB is the leading cause of death among persons infected with HIV in Africa. Worldwide, 1 in 4 TB deaths is HIV-related.

While the calculus seems straightforward — get HIV, see your immune system falter, then get TB — the tangled tango between the two deadly diseases is more complex.

According to the U.S. National Institutes of Health Division of Acquired Immunodeficiency Syndrome,  the presence of TB accelerates the progression of HIV into AIDS, while HIV increases the chances of getting TB.

And treatment? While the World Health Organization estimates that one-third of the global population may currently have the bacterium that causes tuberculosis, the treatment — a yearlong regimen of drugs developed more than four decades ago — can, in the absence of HIV, usually restore health. But those who have both diseases face a much more difficult situation.

Despite the way they seem to gravitate toward one another, the pathways to treating the two diseases are very different. For example, says Dr. Gene Morse, associate dean of clinical pharmacology at the University of Buffalo, “TB can be targeted with an acute treatment period to get the bacteria to stop growing,” which is followed by less intensive therapy during a slower growth phase, and “if treatment is successful, we can stop the drugs.”

“HIV on the other hand, requires lifelong treatment that includes dealing with chronic inflammatory states and other conditions.”

Complicating matters, “the HIV treatment can have a direct effect on how well the TB treatment will work,” Morse says, citing research that shows Rifampin, a first-line TB therapy, can reduce effectiveness of antiretroviral drugs that suppress HIV’s advance.

Some experts have recommended patients delay antiretroviral treatments until they have been treated for TB — a trade-off that means patients increase the risk of their HIV progressing to AIDS during this uncontrolled interim. And, according to a source at the Health Division of Acquired Immunodeficiency Syndrome, the possibility of inadequate treatment of the persistent and adaptive pathogens of both diseases can become “the perfect setup for developing resistant TB that can spread to the rest of the community.”

So researchers are examining the means to treat the two diseases together, rather than separately.

“You can’t bring a lot of people who have TB into a clinic where you have people in the waiting room who have HIV and don’t have TB,” he explains. This is especially true when doing research in low-resource settings that lack sophisticated medical facilities.

With decades of experience in HIV drug development, Morse says now is the time to “synergize our energies and knowledge with HIV and TB” through better collaboration between the HIV and TB research communities. He recommends leveraging advanced information technology to coordinate TB and HIV clinical research programs worldwide, maximizing program efficacy and minimizing adverse drug interactions.

Today’s electronic data collection technology makes it possible to track lots of health parameters for individual patients, and Morse says with the addition of links between health systems and academia to provide real-time feedback into the research process, “the idea of fast-track development can be accelerated through health information technology.”

But technology is not the last word. He envisions a patient centered “Global HIV-TB Wellness and Research Initiative,” so named to inspire patients to “feel positive” about the approach.

Such a system will require harmonization of institutional review board procedures to assure ethical patient protections regardless of where participants are treated. Morse says it is important also to involve ministries of health and local leadership and stakeholders from the affected countries throughout the research process. And success will further require broad-based technology transfer and training, to assure the highest quality care for the patients and data for the research.

Addressing a TB/HIV dual disease research initiative, “The major barrier is money,” says George Atkinson,  the CEO of Institute on Science for Global Policy and former science adviser to former U.S. State Department officials Colin Powell and Condoleezza Rice. He says that in donor countries, such as the United States, TB/HIV co-infection is not widely considered a major public health crisis.

“It’s a question of convincing people that these are opportunities that will protect their families much better than they are today,” Atkinson says. The bottom line, he adds, is this is a case that scientists will have to make directly with policymakers.

But Morse says that in addition to protecting lives, the prospect of examining TB and HIV in a coordinated fashion offers an additional opportunity.

“The nature of these two diseases is such that we can gain a lot of knowledge from looking at how these diseases are treated long term.” And that aggregate knowledge, he says, can be applied to treating other “complex long term medical conditions and these may include vexing public health concerns such as cancer and cardiovascular illnesses.”

Subscribe to Miller-McCune

David Richardson
David Richardson began his journalism career operating a video news service in Washington, D.C., that covered federal agencies and Congress. His film production work has since ranged from postings at the White House to rural villages of Botswana, documenting community-centered HIV prevention programs. He holds a B.A. degree in government from Dartmouth College. He now writes on science, the environment and policy from Baltimore, Md., where he's had some success growing organic produce in a small backyard garden.

More From David Richardson

A weekly roundup of the best of Pacific Standard and PSmag.com, delivered straight to your inbox.

Recent Posts

July 25 • 4:00 PM

Flying Blind: The View From 30,000 Feet Puts Everything in Perspective

Next time you find yourself in an airplane, consider keeping your phone turned off and the window open.


July 25 • 2:00 PM

Trophy Scarves: Race, Gender, and the Woman-as-Prop Trope

Social inequality unapologetically laid bare.


July 25 • 1:51 PM

Confusing Population Change With Migration

A lot of population change is baked into a region from migration that happened decades ago.


July 25 • 1:37 PM

Do Not Tell Your Kids That Eating Vegetables Will Make Them Stronger

Instead, hand them over in silence. Or, market them as the most delicious snack known to mankind.



July 25 • 11:07 AM

The West’s Groundwater Is Being Sucked Dry

Scientists were stunned to discover just how much groundwater has been lost from beneath the Colorado River over the past 10 years.


July 25 • 10:00 AM

Shelf Help: New Book Reviews in 100 Words or Less

What you need to know about Bad Feminist, XL Love, and The Birth of Korean Cool.



July 25 • 8:00 AM

The Consequences of Curing Childhood Cancer

The majority of American children with cancer will be cured, but it may leave them unable to have children of their own. Should preserving fertility in cancer survivors be a research priority?


July 25 • 6:00 AM

Men Find Caring, Understanding Responses Sexy. Women, Not So Much

For women looking to attract a man, there are advantages to being a caring conversationalist. But new research finds it doesn’t work the other way around.


July 25 • 4:00 AM

Arizona’s Double-Talk on Execution and Torture

The state is certain that Joseph Wood’s death was totally constitutional. But they’re looking into it.


July 24 • 4:00 PM

Overweight Americans Have the Lowest Risk of Premature Death

Why do we use the term “normal weight” when talking about BMI? What’s presented as normal certainly isn’t the norm, and it may not even be what’s most healthy.


July 24 • 2:00 PM

California’s Lax Policing of the Fracking Industry Has Put the Drought-Stricken State in a Terrible Situation

The state’s drought has forced farmers to rely on groundwater, even as aquifers have been intentionally polluted due to exemptions for the oil industry.


July 24 • 12:00 PM

What’s in a Name? The Problem With Washington’s Football Team

A senior advisor to the National Congress of American Indians once threw an embarrassing themed party that involved headdresses. He regrets that costume now, but knows his experience is one many others can relate to.


July 24 • 11:00 AM

How Wildlife Declines Are Leading to Slavery and Terrorism

As wildlife numbers dwindle, wildlife crimes are rising—and that’s fueling a raft of heinous crimes committed against humans.


July 24 • 10:58 AM

How the Supremes Pick Their Cases—and Why Obamacare Is Safe for Now

The opponents of Obamacare who went one for two in circuit court rulings earlier this week are unlikely to see their cases reach the Supreme Court.



July 24 • 9:48 AM

The People Who Are Scared of Dogs

While more people fear snakes or spiders, with dogs everywhere, cynophobia makes everyday public life a constant challenge.


July 24 • 8:00 AM

Newton’s Needle: On Scientific Self-Experimentation

It is all too easy to treat science as a platform that allows the observer to hover over the messiness of life, unobserved and untouched. But by remembering the role of the body in science, perhaps we humanize it as well.


July 24 • 6:00 AM

Commercializing the Counterculture: How the Summer Music Festival Went Mainstream

With painted Volkswagen buses, talk of “free love,” and other reminders of the Woodstock era replaced by advertising and corporate sponsorships, hippie culture may be dying, but a new subculture—a sort of purgatory between hipster and hippie—is on the rise.


July 24 • 5:00 AM

In Praise of Our Short Attention Spans

Maybe there’s a good reason why it seems like there’s been a decline in our our ability to concentrate for a prolonged period of time.


July 24 • 4:00 AM

How Stereotypes Take Shape

New research from Scotland finds they’re an unfortunate product of the way we process and share information.


July 23 • 4:00 PM

Who Doesn’t Like Atheists?

The Pew Research Center asked Americans of varying religious affiliations how they felt about each other.


July 23 • 2:00 PM

We Need to Start Tracking Patient Harm and Medical Mistakes Now

Top patient-safety experts call on Congress to step in and, among other steps, give the Centers for Disease Control and Prevention wider responsibility for measuring medical mistakes.


July 23 • 12:19 PM

How a CEO’s Fiery Battle Speeches Can Shape Ethical Behavior

CEO war speech might inspire ethical decisions internally and unethical ones among competing companies.


Follow us


Subscribe Now

Do Not Tell Your Kids That Eating Vegetables Will Make Them Stronger

Instead, hand them over in silence. Or, market them as the most delicious snack known to mankind.

The West’s Groundwater Is Being Sucked Dry

Scientists were stunned to discover just how much groundwater has been lost from beneath the Colorado River over the past 10 years.

How Wildlife Declines Are Leading to Slavery and Terrorism

As wildlife numbers dwindle, wildlife crimes are rising—and that's fueling a raft of heinous crimes committed against humans.

How a CEO’s Fiery Battle Speeches Can Shape Ethical Behavior

CEO war speech might inspire ethical decisions internally and unethical ones among competing companies.

Modern Technology Still Doesn’t Protect Americans From Deadly Landslides

No landslide monitoring or warning systems are being used to protect vulnerable communities.

The Big One

Today, the United States produces less than two percent of the clothing purchased by Americans. In 1990, it produced nearly 50 percent. July/August 2014

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.