Half a million TB deaths in people with HIV in 2008

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Half a million people with HIV died of TB during 2008, according to new figures released this week by the World Health Organization, and TB continues to be the major cause of death among people living with HIV globally.

The figures update the Global Tuberculosis Control Report, issued in March 2009, which reported data to the end of 2007.

The progress update provides information on country and regional performance in implementing some key interventions that could reduce the burden of TB among people with HIV.

Glossary

multidrug-resistant tuberculosis (MDR-TB)

A specific form of drug-resistant TB, due to bacilli resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs. MDR-TB usually occurs when treatment is interrupted, thus allowing organisms in which mutations for drug resistance have occurred to proliferate.

active TB

Active disease caused by Mycobacterium tuberculosis, as evidenced by a confirmatory culture, or, in the absence of culture, suggestive clinical symptoms.

isoniazid

An antibiotic that works by stopping the growth of bacteria. It is used with other medications to treat active tuberculosis (TB) infections, and on its own to prevent active TB in people who may be infected with the bacteria without showing any symptoms (latent TB). 

cure

To eliminate a disease or a condition in an individual, or to fully restore health. A cure for HIV infection is one of the ultimate long-term goals of research today. It refers to a strategy or strategies that would eliminate HIV from a person’s body, or permanently control the virus and render it unable to cause disease. A ‘sterilising’ cure would completely eliminate the virus. A ‘functional’ cure would suppress HIV viral load, keeping it below the level of detection without the use of ART. The virus would not be eliminated from the body but would be effectively controlled and prevented from causing any illness. 

treatment failure

Inability of a medical therapy to achieve the desired results. 

WHO recommends that all TB patients should be tested for HIV, and that all HIV-positive TB patients should receive cotrimoxazole. New treatment guidelines issued on November 30th recommend that all people with HIV diagnosed with TB should receive antiretroviral therapy, regardless of CD4 count.

WHO also recommends that all people with HIV exposed to TB should receive isoniazid preventive therapy to reduce the risk of developing active tuberculosis, and that all people diagnosed with HIV infection should be screened for active TB.

Almost 1.4 million TB patients learnt their HIV status during 2008 - around 22% of all global TB cases - and 50 countries achieved HIV testing rates of at least 75% among TB patients.

Across sub-Saharan Africa the average HIV testing rate in TB patients was 45%, but 11 countries in the region achieved rates of at least 75%. However WHO estimates that only 27% of HIV-infected TB cases were actually identified through testing last year in the region

However, TB screening in people living with HIV was still very limited in 2008. Only 1.4 million people were screened, compared with 600,000 in 2007, a global screening rate of 4.1%.

One-third of HIV-positive TB patients received antiretroviral therapy in 2008, and 71% received cotrimoxazole prophylaxis. But provision of isoniazid preventive therapy was still very limited – just 50,000 people with HIV received it last year, despite the fact that one-third of the world’s population is estimated to have been exposed to TB.

WHO also reported on progress towards global targets for curing TB infections, and on cases of multi-drug resistant TB.

5.7 million people were treated for TB in 2008, with a global success rate of 87%. WHO recommends a national target of at least 85%; 50 countries achieved cure rates at this level, including Tanzania and Kenya, both countries with high burdens of TB/HIV coinfection.

Treatment failure can result in the development of multi-drug resistant TB (MDR). Just under 30,000 cases of MDR TB were reported in 2008, but WHO estimates that no more than 11% of cases of MDR TB were actually detected and notified to national authorities last year.

Around 6,000 MDR TB cases received treatment, indicating the need for a rapid expansion of diagnostic and treatment facilities for people with MDR TB.

WHO Stop TB director Dr Mario Raviglione said that $2 billion is needed globally in order to expand TB services.