An estimated 10-15 million Americans are infected with TB bacteria, all with the potential to develop active TB disease in the future. About 10 percent of these infected individuals will develop active TB at some point in their lives. However, the risk of developing TB disease is much greater for those infected with HIV and living with AIDS. Because HIV infection so severely weakens the immune system, people dually infected with HIV and TB have a 100 times greater risk of developing active TB disease and becoming infectious compared to people not infected with HIV.
The Centers for Disease Control (CDC) estimates that 10 to 15 percent of all TB cases and nearly 30 percent of cases among people ages 25 to 44 are occurring in HIV+ people.
This high level of risk underscores the critical need for targeted TB screening and preventive treatment programs for HIV-infected people and those at greatest risk for HIV infection.
All people infected with HIV should be tested for TB, and, if infected, complete preventive therapy as soon as possible in order to prevent active TB.
The Intersection of Two Global EpidemicsHIV and TB are two worldwide epidemics that intersect becoming one public health nightmare. Consider these facts:
- Approximately 2 billion people (one-third of the world's population) are infected with Mycobacterium tuberculosis, the bacteria that causes TB.
- TB is the cause of death for one out of every three people with AIDS worldwide.
- The spread of the HIV epidemic has significantly impacted the TB epidemic; one-third of the increase in TB cases over the last five years can be attributed to the HIV epidemic.
The Continued Threat of Multi-drug Resistant TBThere are effective treatments for active TB. But there are some strains or types of TB that do not respond to the antibiotics used to treat TB. These types of TB are called Multidrug-resistant TB. Every nation must face the challenge of combating multi-drug resistant (MDR) TB. People infected with HIV and living with AIDS are at greater risk for developing MDR TB. MDR TB is extremely difficult to treat and can be fatal. While the number of cases in the United States has remained stable over the past few years, cases of MDR TB have now been reported from 43 states and the District of Columbia.
To prevent the continued emergence of drug-resistant strains of TB, treatment for TB must be improved in the United States and across the globe. Inconsistent or partial treatment is the main cause of TB that is resistant to available drugs. The most effective strategy for ensuring completion of treatment is Directly Observed Therapy. Simply put, directly observed therapy is exactly what its name suggests. People who are taking TB treatment are observed taking their doses each day in order to assure that the doses are taking each and every day to completion. TB prevention and treatment experts feel that expanding the use of directly observed therapy could be an effective way to assure TB treatment is completed and as a result the incidence of multi-drug resistant TB would decline.
Another challenge that individuals co-infected with HIV and TB face is the possible complications that can occur when taking HIV treatment regimens along with TB treatment. Physicians prescribing these drugs must carefully consider all potential interactions and must monitor the dual infected patient very closely.
Addressing the Dangers of the TB - HIV ConnectionTB control is an exercise in vigilance. The goal of controlling and eventually eliminating TB requires a targeted and continuous effort to address the prevention and treatment needs for those most at risk, including HIV-infected individuals. Efforts to eliminate TB are therefore essential to reducing the global toll of HIV and TB.
Adapted from an article from the Centers for Disease Control, 2000