Tuberculosis and HIV--Needed: A New Paradigm for the Control and Management of Linked Epidemics

Simon J. Tsiouris, MD, MPH (corresponding author); Neel R. Gandhi, MD; Wafaa M. El-Sadr, MD, MPH; Gerald Friedland, MD

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Introduction

Tuberculosis (TB) and human immunodeficiency virus (HIV) disease have been closely entwined since the early years of the HIV/AIDS pandemic. The 2 conditions overlap in their epidemiologic characteristics and clinical manifestations and are both clothed in stigma. They individually carry the risk of creating social, economic, and political instability, which is markedly worsened when they affect a region in concert. The overwhelming burden of disease due to both TB and HIV is borne by resource-limited countries[1] and the hardest hit among these are in sub-Saharan Africa.

In sub-Saharan Africa, the HIV epidemic is accelerating what was already a massive TB epidemic, with the incidence rate of TB increasing from 146 per 100,000 in 1990 to 345 per 100,000 in 2003.[2] Each disease contributes to the morbidity and mortality of the other. TB is now the leading cause of death among persons with HIV disease. HIV increases the risk of reactivation of latent TB infection (LTBI) and progression to active TB disease more than any other known risk factor. In some countries, the percentage of patients with active TB who are coinfected with HIV is now greater than 60%.[2] Even with appropriate management of TB, patients with HIV co-infection have increased mortality as a consequence of HIV-related complications.[3]

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