Very few people know about the complex association of Tuberculosis (TB) with chronic diseases such as HIV and diabetes– an often overlooked connection– even as TB remains a major global health issue. Though TB is an infectious disease, conditions like HIV and diabetes weaken the immune system, making the body more susceptible to TB and worsening disease outcomes. Such interplay not only makes treatment difficult but also indicates the necessity of integrated healthcare approaches.
India, which had the largest TB burden in 2023, had 26% of the global TB cases and deaths, according to the Global Tuberculosis Report 2024. With more than 55.9% of cases in only five nations—India, Indonesia, China, the Philippines, and Pakistan—the urgent need to tackle TB among chronic diseases has never been more pressing. Dr. Aakashneel Bhattacharya, Consultant, Infectious Diseases, Paras Health, Gurugram shares how HIV and Diabetes connected to TB.
HIV and TB: A Dangerous Coinfection
HIV and TB constitute a deadly duo, with each exacerbating the impact of the other. HIV weakens the immune system, making people much more susceptible to TB infection. Research has shown that individuals living with HIV are much more likely to get TB than uninfected people. TB is also the primary cause of mortality in HIV-positive individuals, especially in regions where HIV is highly prevalent like sub-Saharan Africa.
One of the biggest challenges in HIV-TB coinfection is diagnosis. TB symptoms often appear differently in people with HIV, making detection complex. In addition, managing treatment is difficult since both TB and HIV drugs need to be carefully coordinated to prevent any adverse or harmful drug interactions. With these risks in mind, integrated care models that combine TB and HIV screening, early detection, and well-coordinated treatment plans are essential in reducing mortality and improving patient outcomes.
Diabetes and TB: A Growing Public Health Concern
Diabetes, a chronic condition that infects millions globally, is emerging as a key risk factor for TB. The immune system of people with diabetes is often compromised, so they are 2-3 times more susceptible to developing active TB than those without diabetes. Elevated blood sugar levels (hyperglycemia) impair the body’s ability to fight infections, which results in worsening symptoms of TB, increased recovery periods, and poor treatment outcomes.
The increasing prevalence of diabetes among countries with a high TB burden is particularly challenging. For example, India, which has one of the highest TB burdens in the world, also has more than 77 million people living with diabetes. This dual epidemic makes it critical to integrate TB screening into diabetes management programs and vice versa, providing early diagnosis and care to at-risk individuals.
The Need for Integrated Care Approaches
The interconnectedness of TB, HIV, and diabetes underscores the urgent need for a holistic healthcare strategy that addresses all three diseases simultaneously. Some key areas of focus include:Â Â
– Routine screening and early detection: High-risk groups, including people with HIV and diabetes, should undergo regular TB screening to enable early intervention. Â
– Comprehensive treatment models: Healthcare providers must implement coordinated treatment plans that consider the interactions between TB medications and those used for HIV and diabetes. Â
– Strengthening healthcare systems: Increased investment in diagnostic tools, access to treatment, and cross-sector collaboration is vital for managing TB alongside chronic illnesses. Â
India’s Progress in TB Elimination
India has significantly advanced in TB control, having recorded a 17.7% reduction in TB cases between 2015 and 2023—over twice the average global reduction. The National Tuberculosis Elimination Programme (NTEP) has been at the forefront of this achievement, incorporating the latest diagnostic technology, preventive measures, patient support programs, and multi-sector partnerships to counter TB successfully.
Addressing the links between TB, HIV, and diabetes through integrated and patient-centered healthcare approaches will be vital to reaching this target. By identifying and addressing the intersection of TB with chronic diseases, we can make important strides toward decreasing the worldwide burden of TB and enhancing health outcomes for millions of individuals globally.