The Deadly Intersection Between TB and HIV
Tuberculosis (TB) is a disease that is spread from person-to-person through the air, and
it is particularly dangerous for people infected with HIV. Worldwide, TB is the leading
cause of death among people infected with HIV.
An estimated 10-15 million Americans are infected with TB bacteria, with the potential
to develop active TB disease in the future. About 10 percent of these infected
individuals will develop TB at some point in their lives. However, the risk of
developing TB disease is much greater for those infected with HIV and living with
AIDS. Because HIV infection so severely weakens the immune system, people dually
infected with HIV and TB have a 100 times greater risk of developing active TB disease
and becoming infectious compared to people not infected with HIV. CDC estimates
that 10 to 15 percent of all TB cases and nearly 30 percent of cases among people ages 25
to 44 are occurring in HIV-infected individuals.
This high level of risk underscores the critical need for targeted TB screening and
preventive treatment programs for HIV-infected people and those at greatest risk for
HIV infection. All people infected with HIV should be tested for TB, and, if infected,
complete preventive therapy as soon as possible to prevent TB disease.
Intersection of Two Global Epidemics
Approximately 2 billion people (one-third of the world's population) are infected
with Mycobacterium tuberculosis, the cause of TB. TB is the cause of death for one out of every three people with AIDS worldwide. The spread of the HIV epidemic has significantly impacted the TB epidemic - one-third of the increase in TB cases over the last five years can be attributed to the HIV
epidemic (Source: UNAIDS). The Continued Threat of Multidrug-Resistant TB
Every nation must face the challenge of combating multidrug-resistant (MDR) TB.
People infected with HIV and living with AIDS are at greater risk for developing MDR
TB. MDR TB is extremely difficult to treat and can be fatal. While the number of cases
has remained stable in the United States over the past few years, people with MDR TB
have now been reported from 43 states and the District of Columbia.
To prevent the continued emergence of drug-resistant strains of TB, treatment for TB
must be improved in the United States and across the globe. Inconsistent or partial
treatment is the main cause of TB that is resistant to available drugs (MDR-TB.) The
most effective strategy for ensuring completion of treatment is Directly Observed
Therapy, and its use must be expanded.
Another challenge that individuals co-infected with HIV and TB face is the possible
complications that can occur when taking HIV treatment regimens along with drugs
commonly used to treat TB. Physicians prescribing these drugs must carefully consider
all potential interactions.
Addressing the Dangers of the Interconnected TB/HIV Epidemics Requires Expanded
Efforts
TB control is an exercise in vigilance; the goal of controlling and eventually eliminating
TB requires a targeted and continuous effort to address the prevention and treatment
needs for those most at risk, including HIV-infected individuals. Efforts to eliminate TB
are therefore essential to reducing the global toll of HIV.
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