Improving tuberculosis control programmes and access to highly active antiretroviral treatment is crucial

About a third of the 36 million people living with HIV worldwide are co-infected with mycobacterium tuberculosis; 70% of those co-infected live in sub-Saharan Africa.1 In developing countries half of people with HIV infection will develop active tuberculosis; in some countries in sub-Saharan Africa more than 70% of patients with active tuberculosis are also HIV seropositive.1 Tuberculosis is the leading cause of death among people with HIV infection, accounting for a third of deaths due to AIDS world wide.2 The introduction of highly active antiretroviral therapy has decreased death and opportunistic infections by 60% to 90% among people living with HIV in affluent countries,3 but in developing countries highly active antiretroviral therapy is available to a tiny minority of those who need it. Today there is a shocking inequality worldwide in the prognosis of HIV and tuberculosis co-infection, and it depends on whether patients or their country have access to highly active antiretroviral therapy.

Many regimens have been proposed for treating latent tuberculosis infection; the preferred option is still isoniazid, recommended for nine months.4 In settings …