The cursed duet today: Tuberculosis and HIV-coinfection

Abstract

The tuberculosis (TB) and HIV syndemic continues to rage and are a major public health concern worldwide. This deadly association raises complexity and represent a significant barrier towards TB elimination. TB continues to be the leading cause of death amongst HIV-infected people. This paper reports the challenges that lay ahead and outlines some of the current and future strategies that may be able to address this co-epidemic efficiently. Improved diagnostics, cheaper and more effective drugs, shorter treatment regimens for both drug-sensitive and drug-resistant TB are discussed. Also, special topics on drug interactions, TB-IRIS and TB relapse are also described. Notwithstanding the defeats and meagre investments, diagnosis and management of the two diseases have seen significant and unexpected improvements of late. On the HIV side, expansion of ART coverage, development of new updated guidelines aimed at the universal treatment of those infected, and the increasing availability of newer, more efficacious and less toxic drugs are an essential element to controlling the two epidemics. On the TB side, diagnosis of MDR-TB is becoming easier and faster thanks to the new PCR-based technologies, new anti-TB drugs active against both sensitive and resistant strains (i.e. bedaquiline and delamanid) have been developed and a few more are in the pipeline, new regimens (cheaper, shorter and/or more effective) have been introduced (such as the "Bangladesh regimen") or are being tested for MDR-TB and drug-sensitive-TB. However, still more resources will be required to implement an integrated approach, install new diagnostic tests, and develop simpler and shorter treatment regimens.

Análise Epidemiológica Da Coinfecção Tuberculose/Hiv

“…Referente à forma clínica, identificou-se o predomínio da tuberculose pulmonar, o que corrobora com outros estudos que abordam a coinfecção TB e HIV. Essa forma clínica é caracterizada por sua alta infectividade, desta forma, é premente a confirmação precoce da infecção por tuberculose, para que se possa interromper a cadeia de transmissão dessa doença (13)(14)(15) . Um dos principais fatores que predispõe a alta prevalência dessa forma clínica é a predileção do patógeno pelo parênquima pulmonar.…”

Diagnosis of Tuberculosis in HIV Co‐infected Individuals: Current Status, Challenges and Opportunities for the Future

“…Importantly, TB is the leading infectious cause of death in HIV co‐infected patients . This is supported from a systematic review of autopsy studies of HIV‐infected adults and children , highlighting that diagnosis of TB in HIV co‐infected individuals remains challenging for microbiologists. Methods available for the diagnosis of HIV‐associated TB and recommended by the World Health Organization (WHO) include smear microscopy and mycobacterial culture .…”

Socio-economic status and risk of tuberculosis: a case-control study of HIV-infected patients in Asia

“…TB is the most common HIV-related opportunistic infection and AIDS-related death (2). The management of HIV and TB co-infection is challenging and often associated with poorer treatment outcomes (3) due to their profound effects on the immune system.…”