06

Doctor:
MICHAEL WEIDEN Worst Case: BY: APOORVA
MANDAVILLI

TB + HIV
NYU researchers are hoping to
understand how to treat one
or both diseases without making
the patient worse.

WHEN HIV JOINS FORCES WITH TB, THE people focus on lymphocytes because
i\jlckjZXeY\_fii`ÔZ%K_\e\ZbYlc^\jn`k_cldgjXj they are the intelligent part of the immune
jpjk\d#ÉjXpj;i%N\`[\e%ÈDXZifg_X^\j
Y`^XjXefiXe^\#Ôcc\[n`k_glj$c`b\Õl`[k\\d`e^n`k_ do the dirty work, informed by lympho-
the germs that cause TB. Occasionally, these bacteria cytes. But here they can also be instructed
travel through the blood and lymph vessels, forming by neutrophils.”
lesions in the liver, spleen, and beyond. In chest X-rays, Treating TB in conjunction with HIV is
a lot more complicated than prescribing
it looks as if the lung were studded with small nodules medicines for both. Each group of drugs
the size of millet seeds. ZXedXb\k_\fk_\ic\jj\]]\Zk`m\%N_\e
This gruesome scenario is rarely seen Both types of cells shut down the off doctors know that a patient is infected
n_\eK9`jk_\cfe\X]Õ`Zk`fe%9lkXj?@M switch, allowing HIV to replicate. Other with both diseases, they generally have to
ravages the immune system, TB quickly cell types also secrete proteins that speed ki\Xkk_\K9Ôijk#\dgcfp`e^?@M[il^j
and effortlessly spreads through the body. up HIV’s replication in macrophages and only after the patient has improved. In
HIV’s compounding effect on TB has long increase the rate at which HIV mutates, XYflkfe\`eÔm\ZXj\j#^`m`e^K9[il^j
been known, but recently scientists have making it more virulent. As a result, HIV’s ÔijkgXiX[fo`ZXccpdXb\jk_\gXk`\ekdlZ_
discovered that this pernicious partner- presence in macrophages grows by as worse, a phenomenon no one really under-
ship works both ways. TB, in turn, eases much as 100,000-fold. stands yet. Often, because TB tests can’t
the path of HIV, dismantling the system ;i%N\`[\eXe[_`jZfcc\X^l\jjkl[`\[ detect the bacterium in someone infected
that keeps the virus under control in the these interactions in 16 patients with HIV with HIV, doctors don’t even realize that a
lungs, allowing it to mutate and multiply. and TB. They reported in the May 2007 patient has TB until it’s too late.
“If you have HIV and TB, then TB issue of the Journal of Infectious Diseases that ;i%N\`[\eXe[fk_\ii\j\XiZ_\ijXi\
will kill you much more rapidly,” notes TB infection activates neutrophils, and now trying to tease out the molecular
D`Z_X\cN\`[\e#D%;%#XjjfZ`Xk\gif]\jjfi that these cells are responsible for driv- players involved in interactions between
of medicine and environmental medicine. ing the virus’s replication, a surprising the deadly duo, in the hope that they can
In fact, TB is the leading cause of death Ôe[`e^%Lgkfk_`jgf`ek#?@Mi\j\XiZ_\ij eventually understand how to treat one or
among people who are HIV-positive, had looked primarily at T lymphocytes, both diseases without making the patient
accounting for one-third of AIDS deaths
worldwide.
the virus’s main host in the body. “Most worse.›
Under normal circumstances, the lung
is not a hospitable environment for HIV.
8ef]]jn`kZ_f]jfikjb\\gj`eÕXddXk`fe Estimates of HIV Prevalence in
k_\i\kfXd`e`dld%N`k_flkk_`jjn`kZ_# New TB Cases, 2005
even the smallest of irritants — dust, for ex-
ample — would keep the lung chronically
`eÕXd\[%Le[\ik_\j\Zfe[`k`fej#?@M`j
also held in check. The virus is limited to
infecting perhaps one macrophage — a type
of immune cell that serves as a reservoir for
the virus — out of every 10 million.
But a bacterial infection such as TB
INFOGRAPHIC PETER OUMASKI

changes all that. Attacked by the germs

that cause TB, the lungs respond by re- HIV Prevalence
cruiting neutrophils and T lymphocytes, in TB (ages, 16-49
n_`Z__\cgk_\Yf[pÔ^_kgXk_f^\ej% years)
Neutrophils are deployed early and in No Estimate
great numbers to destroy any foreign 0-4
5-13
invader. T cells are credited with being 20-49
smarter, remembering previous offenders 50 or more
and releasing proteins that regulate the Source: World Health Organization
immune system.

24 NYU PHYSICIAN
+ SUMMER 2008