This abstract from the recently-concluded International AIDS Conference in Mexico is one of the few public documents on a flagship activity of the National AIDS Programme. The refusal rate for HIV testing is not reported. Nor is the rate of TB case-finding among people newly diagnosed with HIV infection. Though one cannot disagree with the conclusion.

[him] moderator

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Epidemiological, clinical, biological characteristics and treatment outcomes of a cohort of HIV-TB patients enrolled in the integrated HIV care for tuberculosis patients program (IHC) in Mandalay, Myanmar

Presented by Min Thwe, Myanmar.

M. Thwe1, W. Maung2, P. Par3, B. Myint4, M. Zaw5, N. Wilson6, S. Hsai Mine7, H. Klughe8, T. Aye9, O. Picard10, P. Clevenbergh11

1National AIDS Program, Ministry of Health, Nay Pyi Taw, Myanmar, 2National Tuberculosis Program, Ministry of Health, Nay Pyi Taw, Myanmar, 3Mandalay General Hospital, Medical Unit 1, Mandalay, Myanmar, 4National Tuberculosis Program, Mandalay, Myanmar, 5National Tuberculosis Program, Nay Pyi Taw, Myanmar, 6International Union Against Tuberculosis and Lung Disease, New Delhi, India, 7International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar, 8World Health Organization, Tuberculosis, Yangon, Myanmar, 9World Health Organization, Tuberculosis, Mandalay, Myanmar, 10Hopital St Antoine, Internal Medicine, Paris, France, 11International Union Against Tuberculosis and Lung Disease, HIV, Mandalay, Myanmar

Background: Myanmar has a concentrated HIV epidemic with an estimated prevalence of 0.7% in the general population, and is one of the 22 high burden tuberculosis (TB) countries. The last estimate of HIV prevalence in TB patients is 10.3%, and about 70% of HIV-infected patients develop TB as their first AIDS-defining event.

Aim: To report the epidemiology, clinical, biological, and treatment outcome aspects of TB/HIV patients enrolled in the IHC program implemented by the public health services, with technical assistance of the Union and support of WHO, Myanmar.

Results: From May 2005 until December 2007, 4498 adult TB patients were tested for HIV, of whom 1511 (34%) patients were HIV-infected and 1039 patients (mean age: 36 years, male: 81%) were enrolled in the IHC program. Risk factors for HIV infection were heterosexual: 93%, homosexual 2%, IVDU 5%. TB diagnosis was: new smear-negative pulmonary TB: 43%; new smear-positive pulmonary TB: 21%; extra-pulmonary TB: 21%; and ‘others’: 15%. TB treatment outcome in HIV-infected versus HIV-negative patients was: cured 72%/83%, treatment completed: 80%/89%, failure: 0.5%/1%, defaulter: 3%/0.5%, transferred out: 2%/2%, death: 11%/2%, respectively (p <0.05). The cumulative number of patients receiving antiretroviral therapy (ART) is 631. Baseline, 6 months and 12 months mean CD4 counts were 142, 172, and 223 cells/µl, respectively. Baseline, 6 months and 12 months mean body weight were: 48, 51, and 53 kg, respectively. The cohort’s cumulative death and defaulters’ rates were 20%, and 5%, respectively. In ART-treated patients, the cumulative death and defaulters’ rates were 8%, and 2%, respectively, after a median follow-up of 524 days.

Conclusion: TB/HIV co-infection rate is 34% in this program. TB-related outcome is significantly worse in TB/HIV patients compared to TB patients. ART-treated patients have a better outcome and retention rate compared to non-ART patients. TB patients should be offered HIV testing and if HIV-infected, receive ART.

http://www.aids2008.org/Pag/Abstracts.aspx?SID=301&AID=8353