Challenges of HIV Coinfections "TB and HCV - the Two Ends in a Sword"

HIV co infections such as TB and HCV infections place an immense burden on health care systems and pose particular diagnostic and therapeutic challenges. Mycobacterium Tuberculosis and HIV, potentiate one another, accelerating the deterioration of the immunological functions. HIV impairs Tumor Necrosis Factor (TNF) mediated macrophage apoptotic response to M.Tuberculosis and facilitates bacterial survival. TNF activates HIV replication indicating the host response initiated against one pathogen may promote the replication of the other. In HIV infected persons TB can be a systemic disease involving multiple organs, which also develops more diffuse lesions. Another drawback is the Immune Reconstitution Syndrome (IRIS) develops in M.Tuberculosis and HIV coinfected Patients who undergo antiTB and antiretroviral therapy. End stage liver disease due to HBV and HCV has become a major cause of death in HIV positive subjects. Access to orthoptic liver transplantation and innovative procedures such as targeted hepatocellular carcinoma therapy is to be facilitated. Health education programs are needed to inform the public about the risk of transmitting infection mechanisms of interaction of the two pathogens still many gaps that need to be filled in order to develop preventive measures against the two diseases.