HIV and tuberculosis: a deadly duo

According to the World Health Organization, 46% of notified tuberculosis (TB) cases also had a positive HIV test in 2012. Approximately 75% of co-infected individuals lived in sub-Saharan Africa. While collaborative HIV/TB activities saved an estimated 1.3 million lives between 2005 and 2011, HIV/TB sufferers face the specter of multi-drug-resistant and extensively-drug-resistant TB. The risk of TB progression is much higher in HIV-infected individuals (8%–10% per year in HIV-infected people not receiving antiretroviral therapy) compared with people without HIV. In 2011, 0.08% of the Russian population has TB and 72% of drug-resistant TB cases were reported compared with 0.47% of TB cases and 8.5% of patients with drug-resistant TB living in South Africa.

With 18% of South African adults infected with HIV in 2009, the country is surpassed in the region only by its neighbor, Swaziland, which has the highest global HIV prevalence among adults in the 15-49 year-old age bracket (26%). Tugela Ferry in South Africa served as ground zero for HIV/drug-resistant TB co-infections. Fifty-three people in a rural hospital were found to be infected with extensively-drug-resistant TB in 2005. Most of the patients who died also had HIV, reinforcing the fact that HIV and TB can form a deadly combination. M. tuberculosis, the infectious agent causing TB, and HIV act in synergy via poorly understood mechanisms, hastening immune dysfunction, with fatal consequences if left untreated (1). Another South African township, Khayelitsha, has one of the highest burdens of HIV and TB in the world. Approximately 70% of township residents had TB and this treatable bacterial infection was the leading cause of death in people with HIV (2).

According to several studies reported on by The New York Times, patients are more likely to live if the infections are managed simultaneously, rather than allowing a lag period to elapse before initiating AIDS treatment.

Sources

1.            Pawlowski A, Jansson M, Skold M, Rottenberg ME, Kallenius G. Tuberculosis and HIV co-infection. PLoS Pathog. 2012;8(2):e1002464.

2.            Mandavilli A. A clash of cultures. Nat Med. 2007;13(3):268-270.