James Chance

Projects: A Duel Threat

Worldwide, TB is the most common cause of death for those infected with HIV/AIDS. At 2.2 percent, Cambodia has one of the highest documented rates of HIV/AIDS infection in Southeast Asia, and also has a very high prevalence of TB: An estimated 65 percent of Cambodians carry the opportunistic virus.

According to the The Cambodian Health Committee, an estimated 100 patients in Cambodia have suspected MDR TB. There a likely many more than that who have not been located and diagnosed. The number of cases located is increasing as the infrastructure to treat it is built. Locating those suffering from the disease is a particular challenge; many patients avoid seeking formal treatment for suspected illness, and transportation to facilities from rural areas is difficult. In this environment, the potential exists for an exponential increase in those suffering from MDR TB given the high rate of HIV infection and malnutrition. In short, MDR TB makes the threat of TB and HIV in Cambodia that much more urgent.

Every three minutes worldwide, a person living with HIV dies of TB. In Cambodia widespread malnutrition, the highest HIV prevalence in SE Asia and a lack of access to treatment for both infections creates an environment where both TB and HIV are likely to increase. According to the WHO, it will take a long-term commitment on the part of both donors and government agencies to sustain and expand treatment integration for HIV and TB. For the thousands of people in Cambodia at risk of coinfection, this commitment cannot come soon enough.

Chen Thea, a 26-year-old transsexual Cambodian woman, is fighting stage three HIV and pulmonary tuberculosis at the MSF TB ward in Siem Reap, Cambodia. Her partner, Chookait, has not left her side in the seven months that she has been hospitalized. TB is the ultimate cause of death for nearly half of people living with HIV/AIDS worldwide.
  
An old photograph of Chen Thea and Chookait sits by their bedside. Worldwide, TB is the most common cause of death for those infected with HIV/AIDS. At 1.9 percent, Cambodia has one of the highest documented rates of HIV/AIDS infection in Southeast Asia, and also has a very high prevalence of TB: An estimated 65 percent of Cambodians carry the opportunistic virus.
  
     
  
Approximately 85 percent of children born in Cambodia are now are vaccinated against TB. However the BCG injection that is used can only safeguard for the first six months of a child's life.
  
Seven year-old Yong was born with HIV as his mother is HIV+. Although he has not been infected with TB, his mother has, and it is likely he will also be exposed to the infection due to its high prevalence in Cambodia.
  
Yong is too young to fully understand his condition. Despite taking medication daily he lives a life much like any other child of his age, running and playing with his sister and other children.
     
  
There is a new threat. Doctors are testing 44-year-old Sok Phalla, who has HIV, for multi drug resistant TB. According to the Cambodian Health Committee, there are an estimated 100 patients in Cambodia with suspected MDR TB. There are likely many more who have not been located and diagnosed as many patients avoid seeking formal treatment for suspected illness, and transportation to formal facilities from rural areas is difficult. In this environment, the potential exists for an exponential increase in those suffering from MDR TB given the high rate of HIV infection and malnutrition that exist here. In short, MDR TB makes the threat of TB and HIV in Cambodia that much more urgent.
  
An MSF doctor performs a pericardial aspiration on Yin Lang, a patient with HIV and TB. The TB has caused pericarditis, a dangerous build-up of fluid around Yin Lang's heart. It is necessary to draw the fluid from the body as it applies increasing pressure on the heart.
  
The World Health Organization recommends Intensified Case Finding for TB when someone is diagnosed with HIV. In regions, like Cambodia, where TB levels are high, early detection and treatment can prolong lives.
     
  
Tem Roeun is being treated for HIV and extra-pulmonary TB (any form of TB which manifests outside of the lungs), which has developed in her spine causing her legs to be temporarily paralyzed.
  
Pulmonary TB accounts for almost 50 percent of the cases that MSF Belgium works with in Siem Reap and Takeo Provinces. In most areas of the world, extra-pulmonary TB only accounts for eight to 10 percent of cases of TB. Research is progressing, but still inconclusive as to why Cambodia has such a high prevalence of this type of infection.
  
A doctor tends to a patient in the TB ward at the MSF clinic in Siem Reap. According to the WHO, it will take a long-term commitment on the part of both donors and government agencies to sustain and expand treatment integration for HIV and TB.  For the thousands of people in Cambodia at risk of co-infection, this commitment cannot come soon enough.