HIV/TB Report from WHO: HIV/TB coinfection rates higher than expected
"This World TB Day is marked by the release of dramatic new data from the World Health Organisation (WHO) showing rates of _TB-HIV co-infection are twice as high as originally estimated.|
Around one-quarter of deaths in people with HIV worldwide were caused by TB in 2007, the World Health Organization said today. Around 450,000 people with HIV died of TB in 2007, WHO estimates, and there were 1.4 million HIV-positive TB cases.
HIV-positive people are around 20 times more likely to develop TB than HIV-negative people in countries with a high HIV prevalence.
The figures were released today in WHO?s 2009 Global tuberculosis control report, and represent a substantial upward revision of previous estimates.."
More people dying from TB are HIV-infected- Report
Last Updated: Tuesday, 24 March 2009, 6:58 GMT
The total number of new tuberculosis (TB) cases remained stable in 2007, and the percentage of the world's population becoming ill with TB has continued the slow decline that was first observed in 2004, according to a new report released by the World Health Organization (WHO) today.
However, the 2009 Global TB Control Report also reveals that one out of four TB deaths is HIV related, twice as many as previously recognized. In 2007, there were an estimated 1.37 million new cases of tuberculosis among HIV-infected people and 456,000 deaths. This figure reflects an improvement in the quality of the country data, which are now more representative and available from more countries than in previous years.
"These findings point to an urgent need to find, prevent and treat tuberculosis in people living with HIV and to test for HIV in all patients with TB in order to provide prevention, treatment and care. Countries can only do that through stronger collaborative programmes and stronger health systems that address both diseases," said Dr Margaret Chan, Director-General of WHO.
The report reveals a sharp increase in HIV testing among people being treated for TB, especially in Africa. In 2004, just 4% of TB patients in the region were tested for HIV; in 2007 that number rose to 37%, with several countries testing more than 75% of TB patients for their HIV status.
Because of increased testing for HIV among TB patients, more people are getting appropriate treatment though the numbers still remain a small fraction of those in need. In 2007, 200 000 HIV-positive TB patients were enrolled on co-trimoxazole treatment to prevent opportunistic infections and 100 000 were on antiretroviral therapy.
"We have to stop people living with HIV from dying of tuberculosis," said Mr Michel Sidibe, Executive Director of UNAIDS. "Universal access to HIV prevention, treatment, care and support must include TB prevention, diagnosis and treatment. When HIV and TB services are combined, they save lives."
TB/HIV co-infection and drug-resistant forms of tuberculosis present the greatest challenges, the report says. In 2007 an estimated 500 000 people had multidrug-resistant TB (MDR-TB), but less than 1% of them were receiving treatments that was known to be based on WHO's recommended standards.
Given the current financial crisis, the report documents concerns over an increasing shortage in funding. Ninety-four countries in which 93% of the world's TB cases occur provided complete financial data for the report. To meet the 2009 milestones in the Stop TB Partnership's Global Plan to Stop TB, the funding shortfall for these 94 countries has risen to about US$ 1.5 billion. Full funding of the Global Plan will achieve its aim of halving TB prevalence and deaths compared with 1990 levels by 2015.
"We have made remarkable progress against both TB and HIV in the last few years. But, TB still kills more people with HIV than any other disease," said Dr Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. "The financial crisis must not derail the implementation of the Global Plan to Stop TB. Now is the time to scale-up financing for effective interventions for the prevention, treatment and care of TB worldwide." __The release of the report today coincides with World TB Day and a 1500-strong gathering at the 3rd Stop TB Partners? Forum in Rio de Janeiro. Next week health leaders and ministers will gather in Beijing in a meeting organized by WHO, the Ministry of Health of the People's Republic of China and the Bill & Melinda Gates Foundation with the aim of securing commitments to actions and funding for drug-resistant TB._
Let sunshine in to fight tuberculosis, WHO says
Tue Mar 24, 2009 10:00am EDT
* Ventilation and sunshine reduce tuberculosis risks
* WHO doubles estimate of HIV patients with tuberculosis
* Hardest-to-treat tuberculosis spreads around the world
By Laura MacInnis
GENEVA, March 24 (Reuters) - Ventilation and some sunshine could go a long way to reduce tuberculosis risks in hospitals and prisons, two strongholds of the contagious lung disease, the World Health Organisation said.
In its latest Global Tuberculosis Control report, released on Tuesday, the United Nations agency also doubled its estimate of how many HIV-infected people catch and die from tuberculosis, and warned especially deadly strains are continuing to spread in all corners of the world.
Mario Raviglione, director of the WHO's Stop TB department, said that because tuberculosis bacteria thrive in stagnant air, "simply opening the doors" can reduce the chances that patients, inmates and others will become infected with the disease that killed about 1.8 million people in 2007.
That global tuberculosis death toll includes 1.3 million HIV-negative people and 456,000 who were also infected with the AIDS virus, deaths from which are strictly classified in health statistics as HIV fatalities.
"You can only die once," explained Kevin De Cock, the WHO's HIV/AIDS Director, who estimated HIV patients whose immunity levels are weak are more than 20 times more likely to catch tuberculosis than the rest of the population.
The WHO's large revision of the number of people with both HIV and tuberculosis reflected "better analyses, better data, and better methodology" and not a real increase in the twin infections between 2006 and 2007, De Cock told a Geneva news briefing.
HIV patients should be screened for tuberculosis and given drugs to reduce their risks of developing the disease, which can be caught by breathing in air droplets from a cough or sneeze of an infected person, the Belgian infectious-disease expert said.
About a third of the world's population is infected with the bacterium that causes tuberculosis, but only a small percentage of people develop the disease, which normally arises when immune levels are weakened due to pregnancy or illness.
The global prevalence of tuberculosis was nearly stable in 2007, with 9.27 million new cases reported compared to 9.24 million in 2006.
Although antibiotics can cure tuberculosis, drug-resistant strains of the disease have proliferated in recent years as a result of medical errors and the failure of patients to take the full six- to nine-month drug treatment course.
The WHO said that about 500,000 people worldwide have been diagnosed with multi-drug-resistant strains of tuberculosis, which cannot be treated with two or more front-line drugs.
And 55 countries and territories worldwide have reported at least one case of "extensively drug-resistant" tuberculosis or XDR-TB, which is virtually untreatable with today's medicines, according to the WHO study.
The actual prevalence of that lethal strain is probably even higher, as few poor countries are currently doing the series of tests required to evaluate the extent of drug resistance in their patients, Raviglione told the Geneva briefing.
AEROPLANES SAFER THAN BUILDINGS
In 2007 an Atlanta lawyer infected with drug-resistant tuberculosis flew to and from Europe for his wedding and honeymoon, and then entered the United States from Canada, triggering an international health scare about the disease.
The same year, a Mexican traveller flew across the U.S.-Mexico border 21 times despite warnings from the Centers for Disease Control and Prevention to U.S. border officials that he also had a drug-resistant tuberculosis strain.
Raviglione, who has led the WHO's tuberculosis fight since 2003, said that transmission risks were only highly acute on flights lasting more than eight hours, and for people sitting within five rows of an infected person.
"In aeroplanes the ventilation system is actually better than in most buildings," he said.
Citing research showing that ultra-violet light can zap tuberculosis bacteria, Raviglione said all efforts to improve natural light in prisons and hospitals could help reduce threats from contagious droplets.
Better air flow through ventilation systems or open windows and doors, and the use of masks in stagnant areas, would also help supplement screenings and antibiotic courses to accomplish the U.N.'s goal of halting and reversing the spread of tuberculosis by 2015.
"It is feasible. What it needs is commitment, some money, and people who know what they are doing," Raviglione said. (For more information about public health and development issues, see www.alertnet.org)
TB, HIV form deadly duo, report warns
By Grace Wong
LONDON, England (CNN) -- More people dying from tuberculosis are infected with HIV than has been previously identified, the World Health Organization says.
One in four tuberculosis deaths is HIV related, according to a new World Health Organization report.
One in four TB deaths worldwide is HIV related, the international health agency said in its 2009 Global TB Control Report released Tuesday. That's twice as many as had been recognized in previous reports.
But the WHO said it also revised earlier estimates of HIV-positive TB cases and deaths due to the recent availability of more representative country information, which means the number of TB deaths among HIV-positive people did not actually double from previous years.
In 2007, there were an estimated 1.37 million new cases of TB among people infected with HIV and 456,000 deaths, the WHO said.
The WHO's annual report on TB monitors the scale of the disease and tracks progress made at controlling it. It was released to coincide with World TB Day, which is observed on March 24 every year.
TB is contagious and spreads through the air when an infected person coughs, spits or sneezes. The disease is found everywhere in the world but is most prevalent in developing countries.
While the total number of new TB cases was little changed in 2007 -- there were 9.27 million new cases versus 9.24 million reported in 2006 -- the rate of TB/HIV co-infection is worrying, experts said.
"We have made remarkable progress against both TB and HIV in the last few years. But, TB still kills more people with HIV than any other disease," Dr. Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said in a statement accompanying the report.
The report found that TB patients, particularly those living in Africa, are increasingly getting tested for HIV. Some 37 percent of people treated for TB in the region were tested for HIV in 2007. That compares to just 4 percent in 2004.
Still, Africa lags behind when compared to other parts of the world. The WHO said several countries reported testing more than 75 percent of patients with TB for HIV.
The WHO also reiterated the danger of a strain of TB that isn't treatable by the usual drugs, known as multidrug-resistant TB.
About half a million people had so-called multidrug-resistant TB in 2007. But the percentage of those receiving the recommended treatment, which can be costly and complicated, was below 1 percent.