Tuberculosis is an opportunistic infection caused by the bacteria Mycobacterium tuberculosis. The infections occurring in people with weak immunity as compared to the people with a healthy immune system are called as opportunistic infections. As, HIV enters the human body, it replicates and weakens the immune system which in turn increases the risk of contracting Tuberculosis in people already suffering from HIV infection.

An HIV and Tuberculosis co-infection occurs when an individual has both, the HIV infection and an either latent or active TB disease simultaneously.  Each disease acts in speeding up the progress of the other, when HIV and TB infection is present together in the body. HIV infection speeds up the progression from latent to active Tuberculosis, Mycobacterium tuberculosis also accelerates the progression of replication and spread of the HIV infection.

HIV infection and Tuberculosis are totally different type of infectious diseases. HIV is a viral infection and TB is a bacterial one. An HIV infected person will not contract TB unless a contact happens with a TB infected person. TB spreads via droplet infection and is communicable. If a person lives in a country with a high prevalence rate of TB, an HIV patient is highly susceptible to contracting the infection. In the similar manner, a person suffering from TB gets infected with the HIV infection only through the blood and bodily fluids borne route, with unprotected sexual intercourse with an HIV infected individual being the most important cause.

Amongst all the other opportunistic infections, TB occurs at an earlier stage in the course of an HIV infection than most other opportunistic infections. Mortality rate in the co-infected patients is more than twice that of HIV infected individuals without a TB infection. Even if a patient is undergoing anti-retroviral therapy, the death rates remain high in co-infected individuals.The natural history and course of TB gets altered in people with an infected immune system. The damage to immunity due to HIV infection causes a drastic reduction in the pathogen killing capacity of the body. In such patients if there is no anti-retroviral treatment prescribed, then the latency period between the infection and progression of disease gets eliminated. 

An active phase of TB is observed in such individuals progressing within a short span of time, ranging from weeks to months, rather than years as it normally should be spanning. Risk of progression from a latent stage to an active stage of TB is around 10-15 times greater in an HIV infected individual as compared to the non-infected person. Such individuals also communicate the disease more rapidly to others.Pulmonary tuberculosis in an HIV infected person can present similar symptoms like that of a classic TB disease. However, a co-infection can sometimes show less presenting TB symptoms, where even the chest X-ray scans can be observed to be normal. A  subclinical  phase of Tb in co-infected patients can cause delay in the diagnosis of the symptoms and subsequently affect the prognosis due to lack of timely treatment.

Social stigma and discrimination has caused an obstacle in provision of adequate treatment for people with HIV. Proper counseling  and initiatives taken to provide indiscriminate care can aid in identification of co-infection and earlier stages. Anti-retroviral treatment teamed up with anti-tubercular drug regimen is prescribed and a successful treatment for drug sensitive cases of TB can be provided with medications for 6-8 months.

How HIV & TB  Are Related?

Sexually Transmitted Diseases (STDs) are the infections that spread primarily from unprotected sexual intercourse or any kind of sexual contact. Men, like women, are equally prone to contracting STDs on having unprotected sexual intercourse; anal, vaginal or oral. Having multiple sex partners just increases the risks of it. So, you need to consult a specialist sexologist if anything these sort of things happening to you:

Common STD Symptoms in Men

Blisters on or around penis 

Spots, bumps or lesions on the penis 

Discharge (clear, white, or yellow) 

Oozing from the tip of the penis (thick or thin) 

Painful urination 

Painful ejaculation 

Itching on the tip of the penis 

Rash on the penis, testicles, or groin

Here is a list of STDs for men

Chlamydia- Chlamydia is a type of bacterial STD transmitted during oral, anal or vaginal sex with an already infected person. Some of the symptoms of Chlamydia in men are swollen testicles, penile discharge or pain while urinating.

Gonorrhea- This is another bacterial infection, majorly affecting the urethra, anus or the throat and primarily spreads through vaginal, oral or anal sex with someone already suffering from it. The symptoms are quite similar to those of Chlamydia.

Hepatitis B- Hepatitis B Virus (HBV) is the cause of the disease Hepatitis B and can cause severe inflammation of the liver. It spreads from one person to the other on coming into contact with the bodily fluids or blood of the person affected. Few signs of Hepatitis B include jaundice, vomiting, nausea, body aches, mild fever, lethargy and appetite loss.

Herpes (Simplex) - It is a viral infection caused by the herpes simplex virus (HSV) and generally tends to develop on or near to the mouth and the genitals. Primarily, herpes spreads through direct contact with the genitals or mouth of a person already diagnosed with the same.

Syphilis- Another bacterial Sexually Transmitted Disease, unprotected oral, vaginal and anal sex are the primary carriers of this disease. It is considered to be one of the most serious STDs because the risks of contracting HIV (Human Immunodeficiency Virus) get magnified once infected with Syphilis.

Human Papillomavirus (HPV) - In men, HPV is capable of causing cancers in the throat, anus or the penis. It is either passed on through skin-to-skin or unprotected sexual contact with an infected partner.

Preventing STDs

Many people can be infected with an STD without experiencing any visible symptoms. This means that practicing safe sex is crucial if you want to prevent STD infection.

The only way to completely prevent an STD is abstinence from any type of sexual contact or contact with open sores and bodily fluids of an infected person. But there are other ways to prevent STDs too.

Condoms during intercourse and dental dams or barriers during oral sex are proven effective when used correctly. Refraining from sex with multiple partners and instead opting for a monogamous sexual relationship can also help to prevent STDs. To understand it better and get treated you can always consult a sexologist.

Common STDs in Men

With changing times the nature and effects of virus and bacteria are also changing and due to this, one of the biggest risks of unprotected sex is catching a sexually transmitted disease or STD. An STD can be contacted by any form of intercourse including oral, vaginal and anal sex. STDs are serious diseases that should not be ignored and require treatment and medication. Some common STDs are:
1. Chlamydia
2. Hepatitis B
3. Genital Herpes
4. Syphilis and
5. Gonorrhea 

The only way to protect yourself from an STD is to abstain from unprotected sex and always use a condom. Sometimes STD infections have no symptoms and can remain dormant for years, hence it is essential to get yourself regularly treated for STDs if you have more than one sexual partner. On the other hand some STDs have visible symptoms such as:

Skin rash
A rash in the genital area is most often a sign of STDs. This can be in the form of bumps, sores or warts. It may or may not be accompanied by itchiness. A rash caused by a STD usually results in redness and inflammation. Herpes sores may subside within a week or so but just because the rash is gone does not mean the infection has been treated. Hence even if the rash disappears before your doctor's visit, ensure you mention it. 

Painful urination
A burning sensation or pain while urinating is a symptom for a number of STDs. There may also be a change in the colour of urine. Some STDs associated with painful urination as Chlamydia, gonorrhea and trichomoniasis. However, this may also be triggered by kidney stones or a urinary tract infection. 

Painful intercourse
Pain during intercourse is one of the most overlooked symptoms of a sexually transmitted disease. While a little pain may be normal, any sudden increase in pain or new type of pain should not be ignored. This should be kept in mind especially when having intercourse with a new partner or if there is a change in sexual habits. When it comes to men's sexual health, pain at the time of ejaculation can be a symptom of a STD.

Abnormal discharge
Abnormal discharge from the vagina or penis can be a symptom of a number of infections not all of which are STDs. Strangely coloured and odorous vaginal discharge can be a symptom of yeast infections or a Sexually transmitted disease like trichomoniasis or gonorrhea. Bleeding in between periods can also be a symptom of a STD.  Abnormal discharge from the penis can be a sign of Chlamydia, gonorrhea or trichomoniasis.

Learn the Signs and Symptoms of STDs

HIV or the human immunodeficiency virus is a retroviral agent that causes the immune system of the body to weaken and lead to cause the acquired immune deficiency syndrome (AIDS). It is now treatable. Research is being conducted all over the world to formulate a targeted drug therapy for combating this life-threatening disease. No vaccine is available, which renders the world population highly susceptible to contract the infection.

HIV infection spreads from an infected person through contact with certain bodily fluids like blood and semen. Spread from one human being to another is called as transmission of HIV. Mother to child transmission, i.e. perinatal transmission is also common. Healthcare and hospital staff are at a great risk of occupational transmission. Other causes of transmission include sharing intravenous drug equipment, needle prick injury, organ transplantation and artificial insemination. Since vaccination and targeted drug therapy for remission are not available, prevention strategies play an important role in curbing the spread of infection.

A three-level prevention strategy is implemented for HIV infection.

Primary prevention- Activities that focus on prevention of uninfected people being infected.
Secondary prevention- Aimed at the provision of proper health care and behavioral facilities for HIV infected people like lifestyle changes, welfare rights advice, anti-discrimination measures.
Tertiary prevention- Aimed at minimizing the symptoms of an infected person; includes the provision of prophylactic drugs and complementary therapies.
The risk avoidance approach for transmission of HIV infection includes certain measures like practicing mutual monogamy & delayed sexual activity in the young population. Safe and appropriate use of syringes and needles is advised. Unnecessary blood transfusions should be completely avoided. Routine screening of HIV antibody should be done.

Risk reduction approach propagates the mandatory use of condoms during sexual intercourse. Sexually transmitted diseases should be treated to avoid the risk of transmitting infection. Sterile syringes should be used. If blood transfusion is necessary, then blood transfused should be evaluated well to meet the quality standards.

If HIV infection is suspected, anti-retroviral drug therapy should be started.
The only universally approved method of HIV transmission during sexual activity is the use of condoms.
Pharmaceutical methods for prevention and treatment include antibiotic drug therapy for sexually transmitted diseases, anti-retroviral drugs for infected individuals, pre and post-exposure prophylaxis and use of low space dead syringes.
Pre-exposure prophylaxis is advised for people who are at a higher than average risk of contracting the infection.
Drug therapy consisting of a combination of Tenofovir and Emtricitabine is prescribed, one per day.
Visit the physician at regular intervals and routine screening is done. Post-exposure prophylaxis is considered to be effective if the treatment is started within an hour of exposure, to effectively reduce the risk of seroconversion. A drug combination of Emtricitabine, Tenofovir and Raltegravir is given.
Social initiatives are undertaken to spread awareness and educate people regarding AIDS. Behavioral change and acceptance of social message is necessary to benefit from the social initiatives. Sex education, LGBT sex education and awareness, safe injection use programs, needle exchange programs, safe sex practice education are some social strategies implemented.
Prevention of transmission of HIV from mothers to children involves anti-retroviral drug therapy during pregnancy and post birth in the newborn child. Breastfeeding is avoided and bottle feeding is advised.

HIV Transmission - How Can It Be Prevented?

HIV infection and AIDS (commonly referred to as HIV/AIDS) are caused by the Human Immunodeficiency Virus (HIV). HIV is transmitted sexually and through exchange of body fluids, such as blood. The HIV attacks our defense system (immune system) giving opportunity to many illnesses to attack the body. These infections (called opportunistic infections) range from common cold and diarrhea to life-threatening illnesses including uncommon pneumonias and cancers. The type, range and intensity of opportunistic infections vary with the severity of the HIV infection and the extent to which our immunity is compromised. 

AIDS is the last stage disorder of the HIV infection. Though there is no complete cure for the HIV-infection till date - despite thousands of scientists across the world working on it, spending countless hours of research involving billions of dollars - there has been tremendous progress in medicare improving the quality of life of the HIV-infected, in extending their life-span to almost normal levels and in preventing mother-child transmission. 

The key factors in extending the life-span, and in keeping good immunity and good health are 

balanced and nutritious diet

regular physical exercise

correct, consistent and lifelong use of the prescribed medicines

periodic medical checkups

staying psychologically positive and strong

good family support and

good lifestyle habits.

The last one involves maintaining good personal hygiene, avoiding smoking (active as well as passive), alcohol, recreational drugs, unhygienic and disease-prone environments and sedentary life style. Those who follow these will guidelines certainly have better prognoses. 

Diet:

A nutritious diet is of utmost importance to the HIV-infected, as adequate nutrition contributes to the development of the immune system, prevents malnutrition and wasting, achieves and maintains optimal body weight and strength, enhances the body s ability to fight opportunistic infections, helps delay the progression of HIV, improves the effectiveness of drug treatments, and improves the quality of life. 

Ensure that the food contains adequate macronutrients, that is, carbohydrates, proteins and fat, otherwise the patient may end up with - protein-energy malnutrition, manifesting itself in the weight loss and wasting that is typical of AIDS patients.

As per WHO, an HIV-infected person has additional nutrient requirements: 10-15 percent additional energy intake and 50 to 100 percent increase in protein intake as compared to a non HIV-infected person.

Consuming micronutrients (especially Vitamins A, B6 and B12, iron and zinc) is important for building a strong immune system and fighting infections.

Try and maintain a daily diet containing rice/roti, vegetables, legumes, and fruits which provide you energy and micronutrients. Choose foods that are low in saturated fat, trans fat, and cholesterol.

Eat at least two servings of fish each week. Oily fish, which contain omega-3 fatty acids, are best. If you cannot eat fish, you can also get omega-3 fats from omega-3 eggs, walnuts, flax seeds.

Better avoid fast foods.

Living with HIV/AIDS: Diet, Nutrition, and Food Safety


- hiv testing in pregnancy should be done early so as standard care can be taken for the pregnant women.


- this hiv testing must be repeated in the third trimester, usually before 36 weeks of gestation. This should be done in women with hiv-seronegative and also in pregnant women who are at a high risk of developing hiv infection.


- expedited hiv tests should be performed at the time of delivery and labor and this is a must in women who have not been documented for hiv. The results of the test should be available in one hour of the test and the testing should be available 24 hours. In case the results are positive then, infant postnatal antiretroviral and intrapartum drug prophylaxis should be started immediately.


- women who have not been able to be tested for hiv at the time of labor and delivery are suggested expedited screening for hiv. Their screening can be done immediately postpartum or their babies should undergo screening. In case the infant and mother, both are positive, then infant antiretroviral drug prophylaxis should be started immediately. These mothers should avoid breastfeeding their babies, until the supplemental hiv tests are negative. In infants with positive hiv, prophylaxis should be discontinued and antiretroviral drug therapy should be started.


- in case of acute hiv infection during pregnancy, that is in the intrapartum period, or during breast feeding, initial testing can be performed with an antigen/antibody combination immunoassay. If the supplemental test is negative, then an additional test which is the virologic test (dna, rna) are necessary for the diagnosis of the hiv infection.
- if the mother is hiv positive then this information must be documented in the infant's medical record and also communicated to the infants care provider.
The knowledge of an antenatal maternal hiv infection allows the:
- women with hiv infection to get the correct antiretroviral therapy along with prophylaxis for the infections which might occur due to the immunocompromised state of the body. This also prevents and decreases the risk of transmission to their partners.
- when there is provision for antiretroviral therapy for the mother during pregnancy and labor along with antiretroviral drug prophylaxis for the baby there is less risk of perinatal transmission of the hiv.
- the hiv infected women should be counseled for a cesarean delivery. The option of an elective cesarean reduces the perinatal transmission of the hiv.
- the hiv women should be counseled about the risk of breastfeeding.

Identification and Management of Perinatal HIV Treatment

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