Last week the Joint United Nations Programme on HIV/AIDS (UNAIDS) reported that there has been a 13% reduction in tuberculosis (TB)-associated HIV deaths in the last two years. The reduction is due to a sharp increase in the numbers of people with HIV and TB co-infection accessing antiretroviral therapy (ART)––a 45% increase between 2009 and 2011.
Yet TB remains the leading cause of death among people living with HIV. UNAIDS and the Stop TB Partnership have signed a new agreement to accelerate action to achieve the 2015 goal of reducing deaths from TB among people living with HIV by 50%.
“We are losing precious lives to TB––which is a preventable and curable disease, and it is in our power to change this. The world will never reach its goal of an AIDS-free generation without tackling TB. It is time to act now,” said Benedict Xaba, Minister of Health of Swaziland, which has the world’s highest rate of TB among people living with HIV.
People living with HIV are 20 to 30 times more likely to develop active TB than people without HIV infection. An estimated 8.7 million people became ill with TB worldwide in 2011, among whom more than 1 million were living with HIV. Pregnant women and children are particularly at risk. If a pregnant woman living with HIV also has TB disease, the risk of death for the mother and child is higher and the risk of HIV transmission to the child more than doubles. In 2011, 430 000 out of 1.7 million AIDS-related deaths (25%) were caused by HIV-associated TB disease.
“TB/HIV is a deadly combination. We can stop people from dying of HIV/TB co-infection through integration and simplification of HIV and TB services”, said Michel Sidibé, Executive Director of UNAIDS. “The 2015 goals are clear—reduce TB deaths in people living with HIV by 50%––we can make this happen, but only if services are scaled up in countries through concerted and joint efforts.”
In 2011, at the United Nations High Level Meeting on AIDS, UN Member States set the target of halving TB/HIV deaths by 2015, which would lead to saving 600 000 lives. Three-quarters of TB/HIV deaths currently occur in just ten countries; Ethiopia, India, Kenya, Mozambique, Nigeria, South Africa, the United Republic of Tanzania, Uganda, Zambia and Zimbabwe. Intensifying efforts in these 10 countries would significantly accelerate progress in achieving the 2015 goal.
“TB is preventable and curable at low cost, yet we still have one in four AIDS-related deaths caused by TB, and this is outrageous. Countries have yet to fully implement the actions needed to address the co-epidemic,” said Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership. “Through a new agreement UNAIDS and the Stop TB Partnership have committed to a strong agenda of action, engaging new partners and assisting the most heavily affected countries as they integrate their HIV and TB services and build action plans.”
The Memorandum of Understanding signed by UNAIDS and the Stop TB Partnership “To achieve zero deaths from TB among people living with HIV” states that the parties will ‘take action….to strategically address the intolerable burden of TB mortality borne by people living with HIV’. The two organizations are developing a detailed work plan and have committed to collaboration to achieve three main objectives within the next three years; increase political commitment and resource mobilization for TB/HIV; strengthen knowledge, capacity and engagement of civil society organizations, affected communities and the private sector; and help most-affected countries integrate TB/HIV services.
Preventing HIV/TB deaths
§ In countries where HIV and TB are prevalent, testing for both should be provided to everyone.
§ People living with HIV are far less likely to become ill with and die of TB if they begin antiretroviral therapy (ART) before their immune systems begin serious decline. All people who are eligible for ART should receive it as early as possible.
§ In addition to earlier ART, people living with HIV should be protected against becoming ill with TB through a daily dose of the drug isoniazid.
§ All people who test positive for HIV and are also found to have TB disease should start TB treatment immediately. After two weeks on TB treatment, they should begin ART, regardless of the status of their immune system.
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