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Should tuberculosis treatment and control be addressed differently in HIV-infected and -uninfected individuals?

¹ International Union Against Tuberculosis and Lung Disease, Paris, France. ² Division of TB Elimination, National Centers for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA

CORRESPONDENCE: P. I. Fujiwara, International Union Against Tuberculosis and Lung Disease, 68 boulevard Saint-Michel, 75006 Paris, France. Fax: 33 143299087. E-mail: PFujiwara@iuatld.org

Keywords: Case management, HIV, treatment, tuberculosis

Received: July 30, 2004
Accepted August 25, 2004

ABSTRACT

Infection with HIV drives the tuberculosis epidemic, especially in sub-Saharan Africa, where up to 75% of individuals with tuberculosis are co-infected with HIV. This article reviews the epidemiological link between the conditions, how tuberculosis diagnosis and treatment differ between HIV-infected versus -uninfected individuals and the span of additional measures required to prevent and control HIV-related tuberculosis.

Tuberculosis chemotherapy using standard short-course regimens is highly effective in both groups, and treatment follows the same principles. It differs in certain aspects, such as when antiretroviral treatment should be started in HIV-infected individuals with tuberculosis and consideration of drug–drug interactions between the rifamycins and certain antiretroviral drugs.

Control of HIV-related tuberculosis requires, fundamentally, control of HIV transmission. Meanwhile, it is necessary to make concentrated efforts to intensify high-quality tuberculosis services employing the directly observed treatment, short-course (DOTS) strategy, carry out extensive research towards an evidence-based model for the expanded scope of collaborative tuberculosis and HIV/AIDS interventions, and ensure efficient implementation of the findings and recommended policies.

The challenge is gigantic, and both robust within-country and international leadership and competent management capabilities will be required, in addition to substantial human and financial resources.

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