Chandrappa arrived at Bagalkot District Hospital unable to fully move his legs. The doctors who examined him quickly discovered he was HIV-positive and on antiretroviral therapy (ART). After studying his medical history, conducting a detailed clinical examination, and discussing the findings among themselves, the doctors ordered an X-ray. The procedure confirmed their suspicions: Chandrappa (not his real name) had developed tuberculosis (TB) of the spine. He immediately began anti-tuberculosis therapy and recovered rapidly. Given the limitations in health care capabilities in remote parts of India, such as this rural area of Karnataka state, chances are that TB of the spine would not have been diagnosed so promptly. But Chandrappa was fortunate that the hospital has integrated TB and HIV services, enabling staff to develop advanced diagnostic skills and offer the best possible treatment and care to patients co-infected with both diseases.
The deadly synergy between HIV and TB is well known. HIV weakens the immune system and makes the body susceptible to such opportunistic infections as TB, while TB infection speeds the progress of HIV-related disease. The higher the number of people living with HIV in a population, the greater the probability that they will contract TB, and the greater the resulting morbidity and mortality, even though TB is a curable disease. In some countries, TB is the greatest killer of people living with HIV.