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.
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.