Because HIV can hasten the progression to active TB, this frequency of co-infection in homeless communities is particularly alarming. Treatment can last from six months to a year. This regimen presents multiple challenges to HIV positive homeless people. INH comes with its own set of side effects including nausea, diarrhea, peripheral neuritis and liver dysfunction. Peripheral neuritis, the most common adverse effect of INH, occurs most frequently in malnourished patients, thus posing a particular threat to many homeless people.
Liver dysfunction is equally hazardous.
These treatment challenges are so overwhelming that co-infected homeless persons must frequently choose between treating their TB or HIV, or have that decision made for them and enforced by public health officials. In the case of the latter, TB always wins out. Arthritis, asthma, diabetes and elevated blood pressure also seem to be more common in homeless populations. Two of the few physical health surveys ever done of homeless people suggest that all of these conditions were reported twice as often by homeless 18-44 year olds than by the population at large. One set of surveys found significantly higher morbidity rates for asthma in homeless individuals of all age groups.