BioEd Online

A huge and growing tuberculosis (TB) epidemic threatens to crush the world's efforts to fight AIDS, health officials, scientists and activists warned at the XVI International AIDS Conference in Toronto, Canada, this Wednesday.

One-third of people infected with HIV are also infected with TB, which is the leading killer of AIDS patients. Research released at the conference on Monday shows that giving patients drugs that suppress the HIV infection along with an anti-TB drug as already recommended by the World Health Organization (WHO) can drastically reduce the risk of people infected with HIV contracting TB.

But governments and funding agencies aren't doing enough to promote integrated treatment, experts at the meeting said. In some cases, governments have actually banned a drug effective against TB.

"In spite of knowing what to do, we're still not doing enough," said Paul Nunn, the World Health Organization's HIV/TB Coordinator.

Source of suffering

Tuberculosis is a curable disease, but it is often not diagnosed until it is advanced and difficult to treat. This is part of the reason why 5,000 people die from TB every day many within weeks of being diagnosed with the disease, according to the World Health Organization.

This tragic fate nearly befell Kenyan AIDS activist Lucy Chesire, who lived for ten years with HIV without serious problems. But when she developed a TB infection she nearly died, and only recovered after undergoing three surgeries and spending seven months in hospital. "Somebody can live with HIV for many years," Chesire said. "The suffering I went through was because of tuberculosis."

Results of a study released at the AIDS conference show that Chesire's suffering might have easily been prevented through a cheap, simple strategy. The study examined 11,000 patients infected with HIV in Brazil, as part of the Consortium to Respond Effectively to the AIDS-TB Epidemic (CREATE), an initiative funded by the Bill and Melinda Gates Foundation and launched by Nelson Mandela in 2004 (see ' Mandela launches fight against HIV and TB').

One group was given antiretroviral drugs to supress the HIV virus. Another group was treated with an anti-TB drug called isoniazid, which costs less than US$1 for a full course. A third group was given both.

Antiretrovirals on their own reduced the risk of TB infection by 51%; isoniazid on its own reduced the risk by 32%. But both drugs together reduced infection rates by at least 67%.

Richard Chaisson, of Johns Hopkins University in Baltimore, Maryland, who led the research, is calling on governments and funding bodies to provide such integrated treatments to patients right away.

On the map

Although the World Health Organization already recommends that countries use integrated strategies for treating HIV and tuberculosis, many nations aren't following this advice.

India and South Africa have banned isoniazid preventive therapy because of fears that over-use may lead to drug resistance, Chaisson says, though he adds there is little evidence that this is really a problem. And other countries have been reluctant to start providing HIV and tuberculosis therapies together because their health-care systems traditionally have treated each disease separately. This could mean that the gains made in providing antiretrovial treatment to HIV-infected patients in these countries will be lost as patients die of tuberculosis.

"Tuberculosis is a direct threat to the success of antiretroviral-drug scale-up," said Kevin De Cock, the World Health Organization's director for HIV. He said that the WHO will convene a meeting this year to examine what can be done to encourage the adoption of more integrated strategies.

In the meantime, other officials called on activists and scientists to raise the profile of tuberculosis on the global scene.

"We need to put this on the map," said Helene Gayle, co-chair of the AIDS conference and president of the large charity CARE International. "We hope tuberculosis will be on the next G8 agenda, and we hope tuberculosis will soon be seen with the same political will as we now see HIV."

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