Epidemiology of tuberculosis and HIV: Recent advances in understanding and responses

Research output: Contribution to journalArticle

Abstract

Although tuberculosis (TB) continues to cause enormous suffering and overwhelm health care systems in areas with high HIV prevalence, there have been a number of recent significant advances in knowledge regarding the epidemiology, management, and control of HIV-related TB. TB remains the most common serious opportunistic infection in people with HIV infection and the leading cause of death. However, there is some reason for optimism. First, two trials addressingwhento start antiretroviral therapy (ART) in HIV-infected adults with newly diagnosed TB have shown that earlier initiation of ART reduces mortality significantly. Second, there is trial evidence of efficacy in giving long-term isoniazid preventive treatment (IPT) to HIV-infected adults in high HIV - prevalence settings where TB reinfection is frequent (much like cotrimoxazole). Third, the search for an inexpensive, rapid, sensitive, and specific TB diagnostic that is able to replace smear and delayed mycobacterial culture has yielded promising results. Responding to massive TB epidemics in high HIV - prevalence settings, the World Health Organization has supplemented its directly observed treatment short-course strategy with one called the 3I's to actively screen and diagnose TB cases (intensified case finding), preventnewcases ofTBwith IPT,andprevent transmission of TB in congregate settings such as hospitals and clinics (infection control). Combating TB in high HIV - prevalence settings requires rapid and massive implementation of the 3I's with initiation of antiretrovirals and more effective efforts to preventnew HIV infections.

Original languageEnglish (US)
Pages (from-to)288-293
Number of pages6
JournalProceedings of the American Thoracic Society
Volume8
Issue number3
DOIs
StatePublished - Jun 1 2011

Keywords

  • Antiretroviral therapy
  • Intensified case finding
  • Preventive treatment
  • Xpert MTB rif

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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