To: Decci who wrote (8308 ) 3/2/1998 10:06:00 PM From: Keiko Respond to of 14328
*** TB AND HIV TESTS ** "If we are able to get HIV tests in the field, that could be enormously helpful in terms of the impact on treatment," Davidson says. " I'm not one who believes that treatable conditions, even if they're not curable, are best left unknown. I think the sooner we can find HIV in out patients, the better." About 2 % of patients in TB Clinics could be expected to test positive for HIV. That estimate is based on data from the pool of people, many of whom are at high risk for HIV, who took HIV tests in 1996, the latest year for which figures are available. Implications for TB treatment are substantial, says Davidson. Current CDC recommendations say adult contacts of TB cases who are HIV positive , including contacts who are skin test positive and very close contacts should get 12 months of isoniazid prophylactic treatment IPT) not the conventional six months. In most instances, health departments expect no more than "a tenuous hold " as Davidson puts it , over people getting IPT. But with co-infected patients, health departments which have the resources to do so usually clamp down much harder by for example. providing directly observed preventive therapy for such patients, says Davidson. Plus, cases of active TB can be much harder to detect among co-infected populations than among HIV -negative populations. Treatment for people with active TB who are HIV infected or who have AIDS may also need to be altered in various ways. Even before the Health Service broke the news of it's turn-about, TB control experts had been sniffing the wind for news on alternative to conventional HIV testing. Recently, Davidson polled NTCA members to learn who was using rapid or non-invasive tests. TB controllers in Washington , DC, replied that they'd been getting an enthusiastic response to Epitope's OraSure test, a non-invasive assay that uses cheek fluid called oral mucosal transudate.Since last June, "all cases, suspects, and contacts have been offered the choice of the Orasure test or the regular test says Dr Kurt Brandt, TB controller in the nations capital. ~~~~ more later ~~~~~