HIV/TB Co-Epidemic Rapidly Spreading In Sub-Saharan Africa

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HIV/TB Co-Epidemic

About one-third of the approximately 40 million HIV-positive peopleworldwide also are living with tuberculosis, according to a reportreleased Thursday by the Forum for Collaborative HIV Research, IANS/Yahoo! Newsreports. According to the report, the HIV/TB co-epidemic rapidly isspreading in sub-Saharan Africa, where the threat of the two diseaseslargely 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 TBcases in sub-Saharan Africa occur among HIV-positive people. HIV/TBcoinfection also could be fueling the increase in drug-resistantstrains of TB, the report said (Dow Jones, 11/2). About10% of people living with HIV/AIDS develop TB annually, according tothe report (FCHR release, 11/2). About 90% of people living withHIV/AIDS will die within months of contracting TB, Stephen Lawn, aresearcher at the University of Cape Town, said (BBC News, 11/2).

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Accordingto the report, many countries in sub-Saharan Africa lack theinfrastructure to adequately diagnose, treat or contain the HIV/TBco-epidemic (IANS/Yahoo! News, 11/2). In addition, SouthAfrica is the only country in sub-Saharan Africa with the laboratorycapacity to diagnose extensively drug-resistant tuberculosis, which isresistant to the two most potent first-line treatments and some of theavailable second-line drugs.

The report recommends the use ofoutbreak-investigation methods to map areas with high prevalence of HIVand drug-resistant TB. The report also calls on governments, scientificbodies and donor organizations to strengthen commitments to fightHIV/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;
  • Researchingdiagnostic tools to determine whether a patient has active TB beforebeginning 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;
  • Mobilizingcommunities to place priority on HIV/TB coinfection research andimplementing programs to treat HIV/TB coinfection (FCHR release, 11/2).

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

Millersaid that donor organizations' efforts to "jointly tackle the challengeof HIV/TB [coinfection] shows that the walls between the two diseasesare finally coming down," adding that the global health community "mustscale those walls, or the HIV/TB co-epidemic will continue to overwhelmus" (FCHR release, 11/2).

Reprinted with permission from kaisernetwork.org. You can view theentire Kaiser DailyHIV/AIDS Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily HIV/AIDS Report ispublished for kaisernetwork.org, a free service of The Henry J. Kaiser FamilyFoundation.

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