Towards universal access to HIV prevention, treatment, care, and support: the role of tuberculosis/HIV collaboration (original) (raw)

2006, The Lancet Infectious Diseases

Tuberculosis is the oldest of the world's current pandemics and causes 8•9 million new cases and 1•7 million deaths annually. The disease is among the most common causes of morbidity and mortality in people living with HIV. However, tuberculosis is more than just part of the global HIV problem; well-resourced tuberculosis programmes are an important part of the solution to scaling-up towards universal access to comprehensive HIV prevention, diagnosis, care, and support. This article reviews the impact of the interactions between tuberculosis and HIV in resourcelimited settings; outlines the recommended programmatic and clinical responses to the dual epidemics, highlighting the role of tuberculosis/HIV collaboration in increasing access to prevention, diagnostic, and treatment services; and reviews progress in the global response to the epidemic of HIV-related tuberculosis. History Soon after the fi rst descriptions of AIDS, 1 tuberculosis that was frequently extrapulmonary, disseminated, and that occurred earlier than other opportunistic infections was described in AIDS patients from Haiti. 2-4 The fi rst reports of high HIV prevalence rates in African tuberculosis patients came from the former Zaire in 1986, 5 and were subsequently confi rmed across sub-Saharan Africa. 6 In response, a joint approach to tackling tuberculosis and HIV was recommended by WHO and the International Union Against Tuberculosis and Lung Diseases in 1988. 7 However, since then, there has been little collaboration between tuberculosis and HIV programmes, and the HIV epidemic, exacerbated by chronic under-funding of health systems, particularly in Africa, has caused a reversal of the gains in tuberculosis control achieved in the early 1980s. 8 Global epidemiology Between 1990 and 2004 tuberculosis incidence has stabilised or fallen steadily in most parts of the world, with the exception of Africa. 8 In sub-Saharan Africa, tuberculosis incidence has risen dramatically, fuelled by the HIV epidemic, especially where adult HIV prevalence is greater than 5% (fi gure 1 and fi gure 2). Between 1990 and 2005, tuberculosis incidence increased 7•0% per year on average in countries with high adult HIV prevalence (>5%) but only 1•3% per year in countries with lower HIV prevalence. 8 Recent publications have reviewed the epidemiology of HIV-related tuberculosis in more detail. 10,11