The HIV-associated tuberculosis epidemic—when will we act?

Abstract

Journal LancetRights Reproduced on this site with permission of Elsevier Ltd. Please see [url] Tuberculosis 3The HIV-associated tuberculosis epidemic-when will we act? Anthony D Harries, Rony Zachariah, Elizabeth L Corbett, Stephen D Lawn, Ezio T Santos-Filho, Rhehab Chimzizi, Mark Harrington, Dermot Maher, Brian G Williams, Kevin M De Cock Despite policies, strategies, and guidelines, the epidemic of HIV-associated tuberculosis continues to rage, particularly in southern Africa. We focus our attention on the regions with the greatest burden of disease, especially sub-Saharan Africa, and concentrate on prevention of tuberculosis in people with HIV infection, a challenge that has been greatly neglected. We argue for a much more aggressive approach to early diagnosis and treatment of HIV infection in aff ected communities, and propose urgent assessment of frequent testing for HIV and early start of antiretroviral treatment (ART). This approach should result in short-term and long-term declines in tuberculosis incidence through individual immune reconstitution and reduced HIV transmission. Implementation of the 3Is policy (intensifi ed tuberculosis case fi nding, infection control, and isoniazid preventive therapy) for prevention of HIV-associated tuberculosis, combined with earlier start of ART, will reduce the burden of tuberculosis in people with HIV infection and provide a safe clinical environment for delivery of ART. Some progress is being made in provision of HIV care to HIV-infected patients with tuberculosis, but too few receive co-trimoxazole prophylaxis and ART. We make practical recommendations about how to improve this situation. Early HIV diagnosis and treatment, the 3Is, and a comprehensive package of HIV care, in association with directly observed therapy, short-course (DOTS) for tuberculosis, form the basis of prevention and control of HIV-associated tuberculosis. This call to action recommends that both HIV and tuberculosis programmes exhort implementation of strategies that are known to be eff ective, and test innovative strategies that could work. The continuing HIV-associated tuberculosis epidemic needs bold but responsible action, without which the future will simply mirror the past.

Asymptomatic HIV-infected Individuals on Antiretroviral Therapy Exhibit Impaired Lung CD4+T-Cell Responses to Mycobacteria

“…Specifically, the proportion of mycobacteria-and influenzaspecific IFN 1 TNF 1 DP CD4 1 T cells were lower than those observed in HIVuninfected adults. IFN-g and TNF play important roles in defense against Mtb (1,9,22) and influenza virus infections (26,27). Our findings suggest preferential depletion of these antigen-specific polyfunctional CD4 1 T cells by HIV and incomplete recovery during long-term ART.…”

“…Pulmonary tuberculosis (TB) causes high morbidity and mortality in HIV-infected individuals (1). Unlike other opportunistic infections, the risk of developing active TB is greatly increased in persons even before significant depletion of CD4 1 T cells in peripheral blood (2).…”

The HIV/AIDS epidemic in sub‐Saharan Africa: thinking ahead on programmatic tasks and related operational research

“…The implementation gaps remain wide, with only 2.5% of 1.9 million eligible individuals screened for TB and only 8.7% of 16 million people placed on isoniazid preventive therapy. There are no global data on infection control [52]. Ways forward to enhance feasibility and uptake of each of these components are urgently needed [52,53].…”

“…There are no global data on infection control [52]. Ways forward to enhance feasibility and uptake of each of these components are urgently needed [52,53]. …”

Impact of Integrating HIV and TB Care and Treatment in a Regional Tuberculosis Hospital in Rural Guatemala

“…Until now, most studies of HIV and TB treatment integration have been conducted in Africa, where the bulk of the TB/HIV co-infection burden exists [17][18][19]. No such studies have been published from the high-TB-burden countries in Central and South America.…”