Nuts and Bolts GAUTAM AHLUWALIA EPIDEMIOLOGICAL NUTS AND BOLTS- What is the Gravity of the Problem for India?

In patients with human immunodeficiency virus (HIV) infection, tuberculosis (TB) is a very important cause of morbidity and mortality. As such, India constitutes one-third of the global TB burden with one death reported every minute due to TB. Each infectious patient results in 10-15 new infections every year. In fact, TB kills more women than all causes of maternal mortality and is responsible for 25 % of all avoidable deaths in developing nations. No wonder, the impact of TB is greatest on the developing countries. On the other hand, there are reports that India has the maximum number people living with HIV/AIDS (PLWHA) in the world. Moreover, the majority of people afflicted with HIV and TB are in the economically active age groups. It is being predicted that if India does not cap the HIV/AIDS epidemic, it would affect the economy of the nation in the coming years1-3. TB is the leading cause of death in HIV patients. The mortality of TB in HIV patients is two fold to four fold more than in HIV negative patients. TB is the cause of death in one out of three PLWHA. TB also accelerates HIV infection by increasing viral load by five to seven fold. TB is not only the most common opportunistic infection (OI), it also increases risk of other opportunistic infections3-5. TB shares a deadly synergism with HIV and increases the risk by 150 times for developing active TB. Individuals infected with tubercle bacilli have a 10% lifetime risk of developing active disease. The risk increases to 10 % per year if they are co-infected with HIV. Consequently, many countries in developing world with a high prevalence of HIV are encountering a