Tuberculosis in resource poor countries

In most countries with limited resources the epidemics of HIV and tuberculosis continue to grow. GOTOBUTTON endnote1 (1) Even with optimal treatment of active tuberculosis, the absolute number of tuberculosis cases will continue to rise if the HIV epidemic is not controlled.1 In this week's BMJ, Zar and colleagues report a randomised controlled trial performed in South Africa on the effect of isoniazid prophylaxis on mortality and the incidence of tuberculosis in children infected with HIV.2 The results of this study suggest that isoniazid prophylaxis may be an effective public health intervention to reduce mortality in HIV infected children in settings with a high prevalence of tuberculosis.2

Today, antiretroviral therapy programmes also offer new opportunities to control tuberculosis.3 4 5 Highly active antiretroviral therapy was shown to decrease the incidence of tuberculosis in HIV positive people by 70% in South Africa4 and 80% in Brazil.5 Although antiretroviral therapy is likely to reduce the incidence of tuberculosis in people infected with HIV, mathematical models have suggested it has limited potential to reduce the burden of tuberculosis within the …