Tuberculosis | HIV/TB Co-Epidemic Rapidly Spreading in Sub-Saharan Africa, Report Says

November 2, 2007

About one-third of the approximately 40 million HIV-positive people worldwide also are living with tuberculosis, according to a report released Thursday by the Forum for Collaborative HIV Research, IANS/Yahoo! News reports. According to the report, the HIV/TB co-epidemic rapidly is spreading in sub-Saharan Africa, where the threat of the two diseases largely has gone unnoticed (IANS/Yahoo! News, 11/2).

The report, titled "HIV-TB Co-Infection: Meeting the Challenge," is based on a symposium and roundtable discussion held in Sydney, Australia, during the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention in July (FCHR release (.pdf), 11/2). According to the report, deaths from HIV/TB coinfection are five times higher than deaths from TB alone (IANS/Yahoo! News, 11/2). In addition, the report also noted that about half of all new TB cases in sub-Saharan Africa occur among HIV-positive people. HIV/TB coinfection also could be fueling the increase in drug-resistant strains of TB, the report said (Dow Jones, 11/2). About 10% of people living with HIV/AIDS develop TB annually, according to the report (FCHR release, 11/2). About 90% of people living with HIV/AIDS will die within months of contracting TB, Stephen Lawn, a researcher at the University of Cape Town, said (BBC News, 11/2).

According to the report, many countries in sub-Saharan Africa lack the infrastructure to adequately diagnose, treat or contain the HIV/TB co-epidemic (IANS/Yahoo! News, 11/2). In addition, South Africa is the only country in sub-Saharan Africa with the laboratory capacity to diagnose extensively drug-resistant tuberculosis, which is resistant to the two most potent first-line treatments and some of the available second-line drugs.

The report recommends the use of outbreak-investigation methods to map areas with high prevalence of HIV and drug-resistant TB. The report also calls on governments, scientific bodies and donor organizations to strengthen commitments to fight HIV/TB coinfection. In addition, the report recommends:

  • Developing rapid diagnostic tests to detect drug-susceptible and drug-resistant TB in HIV-positive adults and children;

  • Developing screening tools and equipping labs with tools to diagnose multi-drug resistant TB and XDR-TB;

  • Researching ways to prevent the spread of TB in health care facilities;

  • Researching diagnostic tools to determine whether a patient has active TB before beginning isoniazid preventive therapy among HIV-positive people;

  • Optimizing treatment of HIV/TB coinfection by better understanding TB and HIV drug interactions;

  • Studying the virological, immunological and microbiological outcomes of HIV/TB coinfection in children;

  • Providing evidence-based models for HIV/TB coinfection programs at local, district and national levels;

  • Mobilizing communities to place priority on HIV/TB coinfection research and implementing programs to treat HIV/TB coinfection (FCHR release, 11/2).

Reaction
Veronica Miller, a report author and director of FCHR, said that the "global threat of HIV/TB [coinfection] is not hypothetical. It is here now. But the science and coordination needed to stop it are utterly insufficient" (IANS/Yahoo! News, 11/2). Diane Havlir, chair of the World Health Organization's TB/HIV Working Group, added that health systems "need integrated HIV/TB services using primary health care to reach the broad population," including research to "determine the best models for care delivery."

Miller said that donor organizations' efforts to "jointly tackle the challenge of HIV/TB [coinfection] shows that the walls between the two diseases are finally coming down," adding that the global health community "must scale those walls, or the HIV/TB co-epidemic will continue to overwhelm us" (FCHR release, 11/2).

Online The report is available online (.pdf).