“We cannot win the battle against AIDS if we do not also fight TB.                                 TB is too often a death sentence for people with AIDS.                                   It does not have to be this way.”

Nelson Mandela

In Africa HIV/AIDS loves best of all to dance with tuberculosis - a terrible dance of the two deadliest pathogens - one is mankind's oldest foe, and the other one of its newest. One is an insidious retrovirus, the other a deadly and difficult-to-treat mycobacterium - and both are deadly. One is recognised as the most lethal single infectious pathogen affecting mankind, the other the second most lethal (and it's actually down to semantics which is which).

Treat one pharmaceutically and the other accelerates (and vice versa). And worst still, in the presence of one, the other is often too difficult to detect until too late...

When we first set out to investigate moxa for TB we were initially advised to exclude all HIV+ patients. We didn't take this advice simply because we realised we realistically couldn't; instead we tentatively started the first pilot study highly alert to the possibility that HIV patients could fail to respond or, worse, might detriorate... and that therefore the Moxafrica enquiry would necessarily fail in Africa). We had no choice but to accept a reality that moxa would be meaningless as a treatment for TB in Africa unless it could at the least not exacerbate or accelerate the HIV. (I should add that we did have some limited anecdotal evidence from here in the UK of CD4 counts rising on HIV patients on moxa and ARV drugs, but we hadn't found a sniff of a sign in any research that moxa helps AIDS patients...)

But after three pilot studies we can categorically state that the anecdotal evidence suggests that both HIV/TB and TB patients BOTH respond positively, in fact anecdotally they can't be distinguished from each other. If this proves to be true (and the RCT should reveal the full story of immune response), this could yet be one of the most unlikely stories in medicine this century.

Here's why....

- 1.2 million of the globally estimated 1.7 million who died from HIV in 2011 did so in Africa.

- In fact 79% of those African deaths attributed to HIV because of known HIV+ status actually died from TB....that's 950,000, or 2,500 every day.

- TB is the "hallmark" of the AIDS epidemic in Africa (and vice versa of course). TB is referred to as "the AIDS defining disease" on the continent in the same way as Karposi's Sarcoma is sometimes described in the US.

- And because they are HIV+ those 950,000 lost lives are recorded officially as AIDS deaths although it's TB that actually carried them off - (another example of the "cloak of silence" phenomenon that hangs over the TB epidemic in Africa).

Overall, if you include the "official" TB statistics, we'd suggest that there may be as many as three African lives lost to this foul bacillus every minute.

And these dreadful figures don't even touch on the pharmaceutical complications of drug resistance...There is precious little information on how DR-TB drugs interact with antiretroviral medicines used to treat HIV/AIDS, for instance, and little in the way of Evidence Based Medicine behind current treatment.

91% of the world's children infected with HIV are African...perhaps 200,000 of AIDS deaths in Africa are children, possibly more.

People living with HIV and who are latently infected with TB are 21, 30 or 34 times more likely to develop active TB disease than people without HIV (take your pick of these figures, since it's clear from them that no-one actually really knows...). Normally it's a 1 in 10 conversion rate from latency to active infection. With my simple understanding of mathematics, I can't make any sort of sense of any of those three figures quoted above.. maybe someone does!!

HIV co-infected patients appear to positively respond to small cone moxa treatment - the Ugandan RCT is testing this hypothesis along with several others.

World AIDS Day hits the street on 1st December every year. 

It's "an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV and to commemorate people who have died." You cannot even begin to consider HIV in Africa (where more than 70% of the world's AIDS-attributed deaths occur) without considering TB - and vice-versa. This was why we chose to ignore the original advice to exclude HIV patients from our first investigations - and it's also why we're posting this today (1st December 2012). It's also why we hope you may be able to do something to help the campaign.