10th Conference on Retroviruses and Opportunistic Infections Boston, MA USA - February 10 -14, 2003

Conf Retroviruses Opportunistic Infect 2003 Feb 10-14;10th: abstract no. 45
S Matic 
WHO Regional Office for Europe, Copenhagen, Denmark

BACKGROUND: Tuberculosis (TB) is the leading killer of people with HIV infection worldwide, and the HIV epidemic has seriously undermined TB control efforts in high prevalence areas. While new tools for TB control are clearly needed, it is imperative that effective public health strategies are implemented as soon as possible. The current global approach for the control of TB is the World Health Organization DOTS strategy (Directly Observed Therapy, Short Course).

METHODS: Grounded in the tradition of passive case detection and treatment of active disease, several epidemiologic analyses demonstrate that the DOTS strategy is insufficient to control TB in countries with high HIV prevalence. The fundamental epidemiology of TB has changed radically in populations with a high prevalence of both HIV and TB. Case rates and mortality from TB are climbing, even in countries or settings where DOTS has been successfully implemented. In these settings, TB is driven by reactivation of latent infection in HIV-infected people, with subsequent transmission to contacts before the disease is recognized and treated. Without a fundamental change in approaches to control this epidemic TB will continue to escalate dramatically in settings of high co-prevalence of HIV and latent TB. Recently, much attention has been focused on HAART, which is known to reduce the incidence of TB by 80% in those who receive it. However, HAART alone may not reduce TB incidence because many people develop TB before they meet guidelines for treatment with HAART. Moreover, among people receiving HAART in countries such as South Africa, rates of TB remain unacceptably high. Additional approaches to controlling TB include active case finding, screening of case contacts, treatment of latent TB infection, and reducing institutional transmission.

RESULTS: Data from a number of recent reports suggest that these strategies may have an important impact on TB incidence.

CONCLUSIONS: More intensive and far-reaching interventions are urgently required to combat TB in Africa, Asia, and Latin America where HIV is rapidly undermining all efforts to contain disease rates.

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Copyright © 2003 - Foundation for Retrovirology and Human Health. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health. Licensed (AIDSLINE) from National Library of Medicine.