Can timing change everything?

A Map of Cambodia: Cambodia Map from CIA World Factbook

Amongst individuals living with HIV, twenty to thirty percent die because of an additional tuberculosis infection. This co-infection is extremely common in Cambodia, a nation with 63,000 out of 13.2-million individuals living with just the HIV diagnosis, which eventually leads to AIDS. The HIV/Tuberculosis co-infection makes up 6.4% of Cambodia’s 5% HIV diagnosed population.

Dr. Anne Goldfeld, who has done studies on this trial as a Harvard Medical School employee and as President of the co- founder of the Cambodian Health Committee, says,


“Tuberculosis claims the lives of more than half a million people with HIV worldwide every year…”

 

She also says,


“This is a tragedy, because TB is completely curable when diagnosed and treated properly even in a patient with advanced HIV, especially if the patient also receives anti-retroviral therapy.”

 

In the past, the treatment for the co-infection has been very consistent. The treatment for Tuberculosis has been given to a patient immediately upon diagnosis. Two months later, anti-retroviral (ART) therapy for HIV would be given. However, recently, a trial entitled CAMELIA , >Cambodian Early versus Late Introduction of Antiretroviral Drugs, has helped give hope to HIV patients. The trial, which was created by Cambodian, French, and

 

American doctors, began in 2006 and lasted until 2010, encouraged five Cambodian hospitals to give HIV treatment to co-infected diagnosed patients only two short weeks following anti-tuberculosis treatment. The five hospitals are Calmette Hospital, Khmero-Soviet Friendship Hospital, and three provincial hospitals in the Siem Reap, Svay Rieng, and Takeo regions. This trial cut down the waiting time for HIV treatment by six weeks and overtime, the trial increased the survival rate of co-infected individuals by 33%.  Could six weeks really change the chance of survival for tuberculosis and HIV co-infected patients by such a great percentage? The answer is: absolutely! Did all medical physicians involved in this field of medicine agree with these techniques used to aid co-infected individuals? The answer is: definitely not.

 

Many of those who were opposed to the trial’s process said that the two treatments of Tuberculosis and the HIV  would wear the body down if done at similar times. Additional difficulties could be created for the body, which could already face toxicity with the required seven pills a day. The treatment was not risk-free either. It was possible that the immune system could become increasingly inflamed as it “rebound[ed] from HIV’s suppressive influence.” This trial was also available to patients who had an extremely strong immune system (given their diagnosis) at the time of treatment. Nevertheless, the benefits of the treatment have been much greater and more substantial than those doctors’ fears holding co-infected individuals from getting treated.

Doctors are still learning how the CAMELIA treatment can be improved and altered for the future. However, there has been enormous success with moving the treatments of co – infected Tuberculosis and HIV patients closer by six weeks. In just Cambodia, 661 patients participated in the CAMELIA trial, and less than one percent of the population participating, missed an appointment of the 8,955 scheduled for the population at the five separate hospitals. Many doctors, Cambodian citizens, and observers wanted this trial to work, and it was happening! The World Health Organization (WHO) should be encouraging this treatment more! Thirty three more percent of the initially co-infected patients of Cambodia are living! So where will the trial go next to help co – infected Tuberculosis and HIV patients? Ethiopia.

Killing Two Birds with One Stone

Credit: Fillmore Photography Flickr

Can you imagine having TWO life threatening diseases? Well, for some in Cambodia, that is the case. HIV and TB are two very common diseases that plague Cambodia, as well as other countries. Typically, a patient would go through TB treatment for two months and then begin HIV treatment. However, a new study done by Dr. Anne Goldfeld, the Program in Cellular and Molecule Medicine at Children’s Hospital Boston, and the CAMELIA (Cambodian Early versus Late Introduction of Antiretrovirals) shows that people with HIV and TB can benefit by being introduced HIV Treatment two weeks, instead of two months, after TB treatment was started. 

Doctors and researchers used to believe that the two medicines too much for the body to handle. Combining these two treatments would include taking seven, yes seven, pills a day. In addition, the pills would actually work against each other, the TB pills would work up the immune system to attack the TB and the HIV pills would suppress the immune system to stop the HIV from getting worse. This would put a massive strain on the body. However, this new study shows that the combination of the treatments can actually benefit the patient.

As of now there is no specific research or answers as to why the combination of the TB treatment and the HIV treatment is so effective. However, the study’s results are definitive. The patients that started the HIV treatment two weeks after starting the TB treatment had a better survival rate than those that started the HIV treatment later, 33% greater, to be exact.

Although the study did not give the exact reason behind this beneficial combination, it opened the door to a multitude of possibilities for HIV and TB sufferers around the world.