Diabetes linked to higher risk of tuberculosis in U.S./Mexico border

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Patients with diabetes are at higher risk of contracting tuberculosis (TB) than non-diabetic patients, according to a study conducted in the Texas/Mexico border.

The prevalence of diabetes among TB patients was 39 percent in Texas and 36 percent in Mexico. Diabetes contributed 25 percent of the TB cases studied, whereas HIV infection contributed only five percent or fewer.

Among TB patients, fewer Mexicans than Texans were aware that they had diabetes before this study (four percent and 19 percent, respectively). Men were also less frequently aware than women that they had diabetes. Patients who knew that they had diabetes before the study had an eight-year history of the disease, on average, before being diagnosed with TB.

1. Restrepo BI, Camerlin AJ, Rahbar MH, et al. Cross-sectional assessment reveals high diabetes prevalence among newly-diagnosed tuberculosis cases. Bulletin of the World Health Organization 2011; 89: 352-359. (open access)

Urban-rural inequities in knowledge of tuberculosis in Pakistan

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Knowledge of tuberculosis (TB) is poor especially in rural areas of Pakistan, according to a study conducted in Pakistan’s Punjab province. The study also found that people living in urban areas were more likely to seek treatment at a health facility, compared to rural folk. TB is re-emerging as a global public health problem and a better understanding of the urban and rural communities’ perception of the disease is needed to implement better prevention and control.

Knowledge regarding symptoms, transmission, prevention, duration of standard treatment and DOTS treatment was significantly higher in urban areas. Although more than 80 percent of both urban and rural people in the study were aware of the correct treatment for TB, less than half knew of the availability of the diagnostic facility and treatment free of cost.

People in the urban areas were more likely to feel ashamed and embarrassed being a TB patient; however, they seem to be supportive in case their family member suffered from TB. Nearly half of the study respondents, irrespective of the area of residence, believed that the community rejects TB patients.

Television (urban 80 percent, rural 68 percent) and health workers (urban 31 percent, rural 41 percent) were the main sources for people to acquire TB-related information.

“Television can be recommended as a suitable medium for future campaigns provided that information should be tailored according to the needs of all people, and health workers can be involved in this regard especially in the rural areas,” the study suggested.

1. Mushtaq MU, Shahid U, Abdullah HM, et al. Urban-rural inequities in knowledge, attitudes and practices regarding tuberculosis in two districts of Pakistan’s Punjab province. International Journal for Equity in Health 2011; 10: 8. (open access)

India: NNRTI drugs raise cholesterol in HIV patients with TB

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Studies have shown that the Indian population in general has a high risk of cardiovascular disease (because of genetic and other factors), and there is concern that HIV infection and treatment with antiretroviral therapy (ART) may increase that risk.

A study conducted in south India found that HIV-positive patients with tuberculosis (TB) who initiated once-daily nonnucleoside reverse-transcriptase inhibitor (NNRTI)–based ART under went complex changes in their cholesterol levels, highlighting the importance of screening and treating other cardiovascular disease risk factors. The patients were also treated with rifampicin-based thrice-weekly antituberculosis treatment.

After 12 months of receiving NNRTI-based ART, HDL, LDL and total cholesterol levels increased significantly. The results that around 25 percent of patients who received an NNRTI-based regimen had an abnormal lipid profile at one year should alert physicians to this outcome and encourage testing, the study authors said.

“Although the current World Health Organization guidelines do not recommend routine monitoring of lipid levels for patients receiving first-line antiretroviral treatment, patients would benefit from an assessment of lipid profiles and other cardiovascular risk factors followed by counseling on risk-reduction strategies,” the study said. “As patients continue to enjoy longer lives as a result of effective treatment, it is important to consider and minimize long-term adverse effects of the disease and its treatment.”

1. Padmapriyadarsini C, Kumar SR, Terrin N, et al. Dyslipidemia among HIV-infected patients with tuberculosis taking once-daily nonnucleoside reverse-transcriptase inhibitor–based antiretroviral therapy in India. Clinical Infectious Diseases 2011; 52(4): 540-546. (open access)

Global Tuberculosis Control Report 2010

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The World Health Organization’s Global Tuberculosis Control Report 2010 demonstrates the progress being made in combating the tuberculosis epidemic, including a 35 percent decline in tuberculosis-related deaths since 1990.

The report, released on 11 November 2010, contains the very latest data on this contagious and airborne disease affecting mostly young adults in their most productive years. For the first time, this annual report also includes online profiles from 212 countries and territories.

“The findings in the Global Tuberculosis Control 2010 publication confirm that when WHO’s best practices are put in place, and with the right amount of funding and commitments from governments, we can turn the tide on the TB epidemic,” said Dr. Mario Raviglione, Director of the WHO Stop TB Department.

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1. World Health Organization. Global Tuberculosis Control Report 2010. Geneva, Switzerland: WHO, 2010. (free access)