Management of co-infection with HIV and TB

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7341.802 (Published 06 April 2002) Cite this as: BMJ 2002;324:802

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

  1. R Colebunders, professor, infectious diseases,
  2. M L Lambert, research assistant
  1. Department of Clinical Sciences, Institute of Tropical Medicine and University Hospital, 2000 Antwerp, Belgium
  2. Department of Public Health

    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 …

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