March 25, 2009

WHO Report: TB, HIV Coinfection Deaths Doubled

In recognition of World Tuberculosis Day, March 24, the World Health Organization (WHO) released new data showing that 1.4 million people living with HIV were newly infected with TB worldwide in 2007. About 456,000 HIV-positive people died from TB that year, which is twice as many as previously estimated. Though the spike resulted from improved data gathering techniques, it makes TB—an infectious disease that affects the lungs—the most common cause of death among HIV-positive people globally.

“The surveillance mechanism that the World Health Organization relies on has not adequately captured just how important HIV-related TB is in Africa,” said Richard Chaisson, MD, of the Consortium to Respond Effectively to the AIDS/TB Epidemic (CREATE), speaking during a conference call on World Tuberculosis Day. “Due to this improved surveillance, we now have very good data showing the incredible impact of the HIV epidemic on tuberculosis and particularly the impact on tuberculosis-related death.”

Researchers have known since the late 1980s that TB and HIV make a deadly combination, particularly in sub-Saharan Africa where 1.1 million people are coinfected. In 2002, the WHO called for a more comprehensive response to HIV and TB, and by 2004, guidelines were in place to produce integrated programs that took on both diseases as a combined threat. Throughout the years, high-profile advocates such as Nelson Mandela and Archbishop Desmond Tutu have emphasized the importance of addressing TB in people with HIV.

A WHO initiative aims to reduce TB in people with HIV by 80 percent by 2015, according to Paul Jensen, global research coordinator for RESULTS Educational Fund. The initiative was estimated to cost roughly $19 billion during the next seven years. However, in light of this newly released data, the actual cost may be far greater.

An additional concern is a multidrug-resistant strain of TB called XDR TB that has been affecting people in South Africa for the past several years and has spread into the HIV community. XDR TB is not yet treatable. “This drug-resistant TB bacteria is uniquely able to exploit the weakest individual and the weakest health care system,” said Carol Hamilton, MD, cochair of the Infectious Disease Center for Global Health Policy and Advocacy. Health officials are alarmed at this potentially untreatable form; it is also gaining ground in China, India and the former Soviet Union.  

Chaisson suggested a three-pronged approach to controlling TB and HIV coinfection. First, he emphasized the need for more-accurate diagnostic TB tests. Second, he called for an improved treatment regimen that could work effectively alongside antiretrovirals. Third, he stressed greater TB prevention for HIV-positive people, which he said is already available but is not being used. Currently, only about 2 percent of all people with HIV get screened for TB.

Health officials are also asking that major global donors invest more into HIV-related TB interventions despite the worldwide recession. Current resources are insufficient and TB policies vary from ambitious to nonexistent, according to “Living With HIV, Dying of TB,” a report by Advocacy to Control Tuberculosis Internationally (ACTION), which evaluated leading HIV programs such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“The financial crisis must not derail the implementation of the Global Plan to Stop TB,” said Michel Kazatchkine, executive director of the Global Fund. “Now is the time to scale up financing for effective interventions for the prevention, treatment and care of TB worldwide.”

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