HIV-TB Co-Infection: the global challenge

Abstract

Tuberculosis was considered to be on the brink of elimination in the developed world until the late 1980s, when new HIV related TB cases and multidrug resistant TB (MDR-TB) emerged. HIV disease is manifested by  immunodeficiency causing disruption of immune surveillance mechanisms, allowing for the development of opportunistic infections among which TB is most prevalent. These two infections place immense burden on health care systems worldwide. During the last two decades, sustained research and public health initiatives on prevention and therapeutic advances have allayed morbidity and mortality due to HIV and TB to a large extent, however more needs to be done. Tuberculosis (TB) is the primary cause of morbidity among HIV-positive people and is the most prevalent opportunistic infection in reactive people. The co-infection of two is one of the major global health challenges in the present time especially for people in developing nations, particularly women and adolescents.[ Dembele et al.,2008] Even with effective immune reconstitution and high CD4 cell counts with antiretroviral therapy, the risk of TB in HIV-infected patients remains high, remaining above the background risk of the general population. [Sterling TR et al., 2010]. It can happen at any stage of the disease and is usually recognised as an early symptom of an undiagnosed AIDS illness. [Corbet et al., 2003] Both the infections interact in a synergistic way, with each accelerating the progression of the other thereby, leading to increased morbidity and mortality.[ Swaminathan S et al.,2010] When compared to HIV-negative patients, HIV-positive patients are twenty times more likely to get this infection. [Tesfaye B et al.,2018] Immunodeficiency in HIV is manifested by the disruption of immune surveillance mechanisms, allowing for the development of opportunistic infections with malignant potential. It also plays a role in co-infection with TB as well. HIV also promotes the advancement of latent tuberculosis infection to disease.[ Ramsay A et al.,2009] Therefore, HIV is the leading cause of failure to reach Tuberculosis (TB) control targets in high-HIV settings, and TB is also a leading cause of mortality among HIV-positive people.[Ahmad S et al.,2010]

Keywords: HIV TB, Co-Infection, global challenge