Time to Double Down on the Link Between HIV and TB

2008 was a great year for public health in sub-Saharan Africa — a year that marked the first decline in AIDS-related deaths on the subcontinent, thanks to an increase in anti-retroviral therapy. But unless we start tackling better care for patients with both HIV and tuberculosis, that drop could be short-lived.

HIV and tuberculosis are dangerously synergistic. Around the world, TB is the leading killer of patients with HIV, according to a new series in Clinical Infectious Diseases. Combined, the two diseases prove much more difficult to treat than they would be individually — especially given the emergence of multi-drug resistant TB. As another article in the 26-report series (a commitment, but definitely worth the time investment) grimly reports, "Together, these infections — 1 viral and 1 bacterial, 1 recently emergent and 1 ancient — kill almost 4 million persons every year, most of whom live in developing nations."

It's a problem that deserves attention beyond medical and public health circles. And it got some last week when, building on this series, the Center for Global Health Policy held a briefing for advocates, journalists and the public. One particularly shocking statistic to emerge from that event? In African countries with the highest prevalence of HIV, over 75% of all TB cases occur in people who are already infected with HIV.

And it's not hard to figure out why. Grouping HIV patients together in treatment settings — whether they have TB or not — is a quick recipe to ensure that most end up with it. (The airborne disease can easily be transmitted through coughing and sneezing.) What's more, because patients with HIV or AIDS have weakened immune systems, they're more vulnerable to TB infection.

At least one model, though — Rwanda — is doing things right. As the authors of the report note, in Rwanda, patients with coinfections receive treatment for both at a clinic that's reserved just for TB patients. Once that treatment is completed, they receive access to HIV/AIDS medications at a regular HIV clinic.

That's a good strategy, but fighting this lethal disease combination will take more than that.

Specifically, HIV medical providers need to be on the lookout for TB, and vice versa. Instead of creating treatment silos, medical providers should be able to care for patients with both HIV and TB. Doctors need to be knowledgeable about drug combinations to make sure patients are getting the most effective treatment. And development of TB medications that can address the multi-drug resistant strain needs to be accelerated. All easier said than done, of course — but also feasible, the authors argue.

With HIV/AIDS patients already threatened by waves of fresh cuts in treatment, it's time to get started.

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