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Title: [The current and future situations of TB/HIV (co-infection of tuberculosis and HIV) in Japan].
Author: Yamada N, Nagai H.
Journal: Kekkaku; 2009 Apr; 84(4):203-11. PubMed ID: 19425395.
Abstract:
While HIV epidemic is still low in Japan, reported HIV infected persons and AIDS cases have been increasing and the tuberculosis epidemiologic situation in Japan is categorized as a intermediate level. Therefore it is necessary to understand the current situations of TB/HIV and identify issues to be addressed for better understanding of the epidemiologic situation of TB/HIV co-infection and improvement of disease control programmes and clinical practice to prevent and treat the TB/HIV. In the symposium, four panelists presented the current situations of TB/HIV in Japan from the views of epidemiology, clinical characteristic, treatment, prognosis and prevention and discussed the issues of them. 2. Clinical charcteristics of patients with HIV and tuberculosis: Hideaki NAGAI (Department of Pulmonary Medicine, National Hospital Organization Tokyo National Hospital). The number of cases with HIV and tuberculosis will increase because of the increment of HIV-infected patients and high morbidity rate of tuberculosis in Japan. It is difficult to diagnose tuberculosis in HIV-infected patients because of atypical chest X-ray, atypical clinical characteristics, extrapulmonary tuberculosis. Side effects, drug-drug interaction, and immune reconstruction syndrome must be considered when the concurrent treatment to HIV and tuberculosis is administered. It is unclear when to start antiretroviral therapy after the initiation of tuberculosis treatment. Careful consideration is needed to initiate antiretroviral therapy. 3. The situation of early detection, the prevention, the treatment and the problem of tuberculosis patients with Human Immunodeficiency Virus infection: Yuka SASAKI (Department of Thoracic Disease, National Hospital Organization Chiba-East National Hospital). We investigated the situation of early detection, the prevention, the treatment and the problem of tuberculosis patients with Human Immunodeficiency Virus infection by the questionnaires. In Japan, many of national organization hospitals with division of thoracic disease did the examination for the patients who were contacted with infectious tuberculosis. Many of physicians expected in the QFT-2G to detect the latent tuberculosis infection in HIV/AIDS patients. The prognosis of the patients with tuberculosis and AIDS has been improving gradually. In future, the specialists of tuberculosis treatment would detected HIV infected patients in tuberculosis patients as possibly early, would do the treatment for the latent tuberculosis infection, and most hospitals would be able to do the AIDS and tuberculosis treatment. 4. Issues in estimating current and future TB/HIV situation in Japan: Norio YAMADA (Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association). The information on HIV seroprevalence of newly diagnosed tuberculosis cases is limited. We carried out cross-sectional seroprevalence survey of hospitalized TB cases. Thirty-three out of 282 hospitals returned the results by the end of March 2008. There are 222 eligible patients at the 33 hospitals. Only one of them is HIV-infected. The prevalence of HIV coinfection adjusted for distribution of notified tuberculosis cases is 0.13%. Taking into account other estimates based on the previously reported studies and AIDS surveillance, it is thought that recent prevalence of HIV co-infection among newly diagnosed tuberculosis cases is at least 0.1% in Japan. Considering low participation rate in the seroprevalence survey and the low epidemic level of HIV in Japan, it might be sensible to establish sentinel surveillance as well as improve the reporting of HIV status included in the tuberculosis surveillance to monitor TB/HIV situation in Japan.

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