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WHO Reports "Flare-Up" of TB/HIV Coinfection Threatens Goal to End TB

WHO representatives warn that a “flare-up” of TB/HIV coinfections coupled with high rates of drug-resistant tuberculosis can threaten progress made towards the elimination of TB.

Although tuberculosis (TB) cases and deaths declined significantly between 2011 and 2015, one subpopulation of patients is being hit harder by TB infections more than ever. Individuals living with HIV showed a 40% increase in coinfection with TB over the same study period.

In a public statement on the matter, the World Health Organization (WHO)’s regional director for Europe, Zsuzsanna Jakab, PhD, warned that, “The flare-up of TB/HIV coinfections...together with persistently high rates of drug-resistant tuberculosis, seriously threaten progress made toward ending TB.” She noted that about a third of people coinfected with TB and HIV often do not know of their HIV status, and, by extension, are less likely to be cured of either. “This favors the spread of the diseases [and] puts health systems and governments under pressure,” she said.

The troubling trend recently came to light after the ninth “Tuberculosis Surveillance and Monitoring in Europe” report was released on March 20, 2017. Overall, the authors reported, there were 323,000 new TB “cases and relapses” in WHO’s designated European region. Although the pace of decline of TB incidents averaged 5.4% per year between 2006 and 2015, the researchers involved in the study noted with concern that the pace slowed to 4.3% between 2011 and 2015, and to 3.3% between 2014 and 2015. “There is a need for faster decline if the region is to meet the target [dates] of End TB Strategy by 2035,” they noted. WHO’s End TB Strategy aims to end the global TB epidemic entirely, and sets benchmarks for TB case reductions. Stated goals are to reduce TB-related deaths by 95% and new cases by 90% between 2015 and 2035.

According to the report, 88.3% of patients who either reported new cases of TB or relapses were screened for HIV; about 9% of those patients tested positive. “This is significantly higher than the 5.5% with HIV-positive status recorded in 2011,” the researchers said, noting that the rising number indicated a rising absolute number of TB/HIV cases in Europe. They pointed to Russia and the Ukraine as particularly troublesome spots for coinfection as well as high rates of coinfections in prisons.

While there are effective treatment options for most TB infections, only about two in every five coinfected patients are successfully treated. Part of the issue, the scientists speculated, could be the emergence of some multidrug-resistant (MDR) strains of TB. The coinfected population’s risk of dying is three times higher than those infected with TB only, and is seven times more likely to fail treatment. Untreated or latent TB infections “can quickly progress to TB disease in people living with HIV because the immune system is already weakened,” reported the researchers. Coinfection creates a “safe” environment for the infections to grow stronger, especially if the patient is unaware of either or both conditions. TB is easily spread because it travels through the air and is breathed into the lungs when infected individuals cough, speak, laugh, or even sing. Although TB tends to attack the lungs, it may also attack the brain or kidneys.

“It is very important to talk to your doctor about getting an HIV test if you think you may have an HIV infection [or TB],” said a Centers for Disease Control and Prevention spokesman. He added that in immunocompromised patients, “TB germs are much more likely to become active and attack the lungs and other parts of the body…so, you must get treatment right away to keep from getting sicker.”