TB & HIV coinfection

TB and HIV often go hand in hand. Programmes therefore need to be integrated to deal with both diseases at the same time, rather than having separate organisations or departments working on the two diseases.

• People who are infected with HIV and have the TB bacteria in their body, have a 5-10% risk of developing TB every year, compared to a 5% lifetime risk for HIV uninfected people who have the TB bacteria in their body.
• WHO recommends that all TB patients should be tested for HIV.
• All HIV-positive TB patients should receive cotrimoxazole.
• All people with HIV diagnosed with TB should receive antiretroviral therapy, regardless of CD4 count. However, in South Africa, it is only being given to those with a CD4 count under 350.
• All people with HIV exposed to TB should receive isoniazid preventive therapy to reduce the risk of developing active tuberculosis.
• All people diagnosed with HIV infection should be screened for active TB.

Across sub-Saharan Africa the average HIV testing rate in TB patients was 45%. However WHO estimates that only 27% of HIV-infected TB cases were actually identified through testing last year in the region.

However, TB screening in people living with HIV was still very limited in 2008. Only 1.4 million people were screened, compared with 600,000 in 2007, a global screening rate of 4.1%.

One-third of HIV-positive TB patients received antiretroviral therapy in 2008, and 71% received cotrimoxazole prophylaxis.

But provision of isoniazid preventive therapy was still very limited – worldwide just 50,000 people with HIV received it last year, despite the fact that one-third of the world’s population is estimated to have been exposed to TB.