Menus Subscribe Search

Follow us


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

October 31 • 4:00 PM

Should the Victims of the War on Drugs Receive Reparations?

A drug war Truth and Reconciliation Commission along the lines of post-apartheid South Africa is a radical idea proposed by the Green Party. Substance.com asks their candidates for New York State’s gubernatorial election to tell us more.


October 31 • 2:00 PM

India’s Struggle to Get Reliable Power to Hundreds of Millions of People

India’s new Prime Minister Narendra Modi is known as a “big thinker” when it comes to energy. But in his country’s case, could thinking big be a huge mistake?


October 31 • 12:00 PM

In the Picture: SNAP Food Benefits, Birthday Cake, and Walmart

In every issue, we fix our gaze on an everyday photograph and chase down facts about details in the frame.


October 31 • 10:15 AM

Levels of Depression Could Be Evaluated Through Measurements of Acoustic Speech

Engineers find tell-tale signs in speech patterns of the depressed.


October 31 • 8:00 AM

Who Wants a Cute Congressman?

You probably do—even if you won’t admit it. In politics, looks aren’t everything, but they’re definitely something.


October 31 • 7:00 AM

Why Scientists Make Promises They Can’t Keep

A research proposal that is totally upfront about the uncertainty of the scientific process and its potential benefits might never pass governmental muster.


October 31 • 6:12 AM

The Psychology of a Horror Movie Fan

Scientists have tried to figure out the appeal of axe murderers and creepy dolls, but it mostly remains a spooky mystery.


October 31 • 4:00 AM

The Power of Third Person Plural on Support for Public Policies

Researchers find citizens react differently to policy proposals when they’re framed as impacting “people,” as opposed to “you.”


October 30 • 4:00 PM

I Should Have Told My High School Students About My Struggle With Drinking

As a teacher, my students confided in me about many harrowing aspects of their lives. I never crossed the line and shared my biggest problem with them—but now I wish I had.


October 30 • 2:00 PM

How Dark Money Got a Mining Company Everything It Wanted

An accidentally released court filing reveals how one company secretly gave money to a non-profit that helped get favorable mining legislation passed.


October 30 • 12:00 PM

The Halloween Industrial Complex

The scariest thing about Halloween might be just how seriously we take it. For this week’s holiday, Americans of all ages will spend more than $5 billion on disposable costumes and bite-size candy.


October 30 • 10:00 AM

Sky’s the Limit: The Case for Selling Air Rights

Lower taxes and debt, increased revenue for the city, and a much better use of space in already dense environments: Selling air rights and encouraging upward growth seem like no-brainers, but NIMBY resistance and philosophical barriers remain.


October 30 • 9:00 AM

Cycles of Fear and Bias in the Criminal Justice System

Exploring the psychological roots of racial disparity in U.S. prisons.


October 30 • 8:00 AM

How Do You Make a Living, Email Newsletter Writer?

Noah Davis talks to Wait But Why writer Tim Urban about the newsletter concept, the research process, and escaping “money-flushing toilet” status.



October 30 • 6:00 AM

Dreamers of the Carbon-Free Dream

Can California go full-renewable?


October 30 • 5:08 AM

We’re Not So Great at Rejecting Each Other

And it’s probably something we should work on.


October 30 • 4:00 AM

He’s Definitely a Liberal—Just Check Out His Brain Scan

New research finds political ideology can be easily determined by examining how one’s brain reacts to disgusting images.


October 29 • 4:00 PM

Should We Prosecute Climate Change Protesters Who Break the Law?

A conversation with Bristol County, Massachusetts, District Attorney Sam Sutter, who dropped steep charges against two climate change protesters.


October 29 • 2:23 PM

Innovation Geography: The Beginning of the End for Silicon Valley

Will a lack of affordable housing hinder the growth of creative start-ups?


October 29 • 2:00 PM

Trapped in the Tobacco Debt Trap

A refinance of Niagara County, New York’s tobacco bonds was good news—but for investors, not taxpayers.


October 29 • 12:00 PM

Purity and Self-Mutilation in Thailand

During the nine-day Phuket Vegetarian Festival, a group of chosen ones known as the mah song torture themselves in order to redirect bad luck and misfortune away from their communities and ensure a year of prosperity.


October 29 • 10:00 AM

Can Proposition 47 Solve California’s Problem With Mass Incarceration?

Reducing penalties for low-level felonies could be the next step in rolling back draconian sentencing laws and addressing the criminal justice system’s long legacy of racism.


October 29 • 9:00 AM

Chronic Fatigue Syndrome and the Brain

Neuroscientists find less—but potentially stronger—white matter in the brains of patients with CFS.


October 29 • 8:00 AM

America’s Bathrooms Are a Total Failure

No matter which American bathroom is crowned in this year’s America’s Best Restroom contest, it will still have a host of terrible flaws.


Follow us


Levels of Depression Could Be Evaluated Through Measurements of Acoustic Speech

Engineers find tell-tale signs in speech patterns of the depressed.

We’re Not So Great at Rejecting Each Other

And it's probably something we should work on.

Chronic Fatigue Syndrome and the Brain

Neuroscientists find less—but potentially stronger—white matter in the brains of patients with CFS.

Incumbents, Pray for Rain

Come next Tuesday, rain could push voters toward safer, more predictable candidates.

Could Economics Benefit From Computer Science Thinking?

Computational complexity could offer new insight into old ideas in biology and, yes, even the dismal science.

The Big One

One town, Champlain, New York, was the source of nearly half the scams targeting small businesses in the United States last year. November/December 2014

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