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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In This Article

Conclusion

The collaboration between HIV and TB programs and services has been hampered by their separate traditions and practices. TB programs are characterized by firmly established algorithms, standardized measures and outcomes, and are designed to treat large numbers of patients with few resources. On the other hand, HIV care and treatment programs are characterized by a patient-centered approach with rapidly evolving treatment paradigms that necessitate frequent revisions of treatment guidelines, accompanied by the need to intensively monitor for efficacy and toxicity over a patient's lifetime. The nuances, subtleties and added complexities of TB diagnosis and appropriate management, including the treatment of drug-resistant TB, in the context of HIV co-infection must be recognized and incorporated into TB care, as must the need for a large-scale public health approach for the management of HIV in resource-limited settings. Each discipline needs to accommodate the other. For the TB world, HIV should no longer be seen as an intruder and must be accepted as part of the current and future reality. For the HIV world, the accumulated experience acquired over the longer history of TB must be valued and can serve as a source of important lessons. How to best harmonize these 2 approaches is at the core of what needs to be rapidly accomplished to effectively manage and control both TB and HIV. Resources provided by international funding sources encouraging and even requiring such harmonization can contribute to this effort but a new spirit of accommodation and collaboration is also required to greatly benefit patients with TB and HIV and establish a new paradigm for the future.

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