TUBERCULOSIS: Inadequacy of screening in AIDS patients

Tuberculosis is a leading cause of death in people with HIV infection, accounting for more than a quarter of the 2 million AIDS deaths in 2008.1 HIV has exacerbated the tuberculosis epidemic globally and especially in Africa—in some sub-Saharan African countries, up to 70% of people with tuberculosis are also HIV positive.2 People with HIV infection also now face the worsening problem of multidrug-resistant and extensively drug-resistant tuberculosis.
Despite remarkable progress in the individual fields of tuberculosis and HIV programming, the gravity and relative neglect of the tuberculosis/HIV crisis deserves further attention. Between 1995 and 2008, the directly observed therapy, short course (DOTS) strategy enabled treatment of 43 million patients with tuberculosis.1 However, until 2004 this strategy did not explicitly include HIV interventions. Furthermore, most HIV services still do not include specific activities for tuberculosis care and prevention. Tuberculosis prevention, screening, and treatment in people with HIV infection remains unsatisfactory. By 2008, only 4% of the 33 million people with HIV infection were screened for tuberculosis, 50 000 received preventive therapy with isoniazid, and just a third of people with both HIV infection and tuberculosis had received treatment for both diseases.1 HIV testing of tuberculosis patients has, however, expanded, to include nearly 1·4 million patients with tuberculosis.1
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