Tuberculosis

WHO Releases Updated TB/HIV Guidance, Claims Nearly 1 Million Lives Saved

The World Health Organization (WHO) reported that more than 900,000 lives were saved over the past 6 years by increased screening and treatment of both HIV and tuberculosis (TB) around the world. Globally, TB is the leading cause of death for people with HIV. This month WHO released updated TB/HIV guidelines for national programs and stakeholders.

The full report is available online.

TB and HIV are overlapping epidemics, most acutely in resource-poor countries. Sub-Saharan Africa is particularly hard hit. TB is the leading cause of death worldwide for people living with HIV. People with HIV are thought to be 20-30 or more times more likely to develop TB than HIV negative people. TB disease is accelerated by HIV infection as well. An infected HIV negative person has a 5%-10% risk of developing active TB disease, while an HIV positive person has a 30% chance.

In 2004 WHO issued guidance for the management of TB and HIV. This guidance focused on increasing the number of people tested for TB through HIV clinics, and for HIV through TB clinics. It was built around the "3 I's" -- Intensified case finding, Isoniazid prophylaxis, and Infection control.

WHO data show that HIV testing for people diagnosed with TB increased by 5-fold, while TB testing for people diagnosed with HIV increased 12-fold. Over 2 million people with TB are tested for HIV annually, with a similar number of people with HIV tested for TB. According to WHO, over 100 countries now routinely test people with TB for HIV -- with the largest changes seen in Africa, where over 30 countries now do so, up from 5 in 2005.

Earlier detection and treatment of TB infection is crucial for both preventing active disease and reducing transmission. Lower CD4 T-cell counts are linked to higher rates of active disease and of extrapulmonary TB affecting parts of the body outside the lungs. People with active disease are much more likely to transmit TB to household members and others in close contact. Providing isoniazid preventative therapy for those at risk has been shown to be highly effective.

Building on these gains, the WHO is expanding its TB/HIV work. These efforts include:

• Routine HIV testing for TB patients, people with symptoms of TB, and their partners or family members;
• Provision of co-trimoxazole (trimethoprim/sulfamethoxazole), a cost-effective medication to prevent lung or other infections for all TB patients infected with HIV;
• Starting all TB patients with HIV on antiretroviral therapy (ART) as soon as possible -- and within the first 2 weeks of starting anti-TB treatment -- regardless of immune system measurements;
• Evidence-based methods to prevent the acquisition of HIV for TB patients and their families and communities.
• Providing TB and HIV serviced in an integrated manner at the same time and place.

"We must address TB as we manage HIV," said Gottfried Hirnschall, director of WHO's HIV/AIDS Department. "We have shown over the last 5 years what can be done. To continue the progress and save more lives, comprehensive HIV services must include the Three I’s for HIV/TB strategy...and it should also include earlier treatment for HIV for those that are eligible."

"This framework is the international standard for the prevention, care, and treatment of TB and HIV patients to reduce deaths, and we have strong evidence that it works," added Mario Raviglione. "Now is the time to build on these actions and break the chain that links TB and HIV with death for so many people."

3/23/12

Sources

World Health Organization. More than 900 000 lives saved by protecting people living with HIV from TB. Press release. March 2, 2012.

World Health Organization.WHO policy on collaborative TB/HIV activities: guidelines for national programmes and other stakeholders. 2012.