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eJIAS: eJournal of the International AIDS Society

Tuberculosis and HIV--Needed: A New Paradigm for the Control and Management of Linked Epidemics

Posted 09/25/2007

Simon J. Tsiouris, MD, MPH (corresponding author); Neel R. Gandhi, MD; Wafaa M. El-Sadr, MD, MPH; Gerald Friedland, MD
Author Information

Introduction

Tuberculosis (TB) and human immunodeficiency virus (HIV) disease have been closely entwined since the early years of the HIV/AIDS pandemic. The 2 conditions overlap in their epidemiologic characteristics and clinical manifestations and are both clothed in stigma. They individually carry the risk of creating social, economic, and political instability, which is markedly worsened when they affect a region in concert. The overwhelming burden of disease due to both TB and HIV is borne by resource-limited countries[1] and the hardest hit among these are in sub-Saharan Africa.

In sub-Saharan Africa, the HIV epidemic is accelerating what was already a massive TB epidemic, with the incidence rate of TB increasing from 146 per 100,000 in 1990 to 345 per 100,000 in 2003.[2] Each disease contributes to the morbidity and mortality of the other. TB is now the leading cause of death among persons with HIV disease. HIV increases the risk of reactivation of latent TB infection (LTBI) and progression to active TB disease more than any other known risk factor. In some countries, the percentage of patients with active TB who are coinfected with HIV is now greater than 60%.[2] Even with appropriate management of TB, patients with HIV co-infection have increased mortality as a consequence of HIV-related complications.[3]

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Author Information

Simon J. Tsiouris, MD, MPH (corresponding author); Assistant Professor of Clinical Medicine and Clinical Epidemiology, Division of Infectious Diseases and Department of Epidemiology, College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, NY

Neel R. Gandhi, MD; Assistant Professor of Medicine, Epidemiology & Population Health Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine, New York, NY

Wafaa M. El-Sadr, MD, MPH; Professor of Clinical Medicine and Epidemiology, International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University and the Division of Infectious Diseases, Harlem Hospital Center, New York, NY

Gerald Friedland, MD; Professor of Medicine, Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut

Author's email: st326@columbia.edu

Disclosure: Simon J. Tsiouris, MD, MPH, has disclosed no relevant financial relationships.

Disclosure: Neel R. Gandhi, MD, has disclosed no relevant financial relationships.

Disclosure: Wafaa M. El-Sadr, MD, MPH, has disclosed no relevant financial relationships.

Disclosure: Gerald Friedland, MD, has disclosed no relevant financial relationships.

Medscape General Medicine.  2007;9(3):62.  ©2007 Medscape

 
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