The Chasm Between HIV and TB

The two worst global health problems have combined forces well. But the institutions addressing them have miserably failed to put their act together.

 A quiet shift took place a few years ago in the impact of global infectious diseases: The human immunodeficiency virus (HIV) epidemic surpassed that of age-old tuberculosis (TB).

In the past five years annual spending on HIV programs increased 16-fold from USD 500 million to around USD 8 billion per year. The same period saw a paltry 70% increase in funding for anti-TB efforts.

The cost to humanity? HIV kills around three million people every year. TB kills two million.

The point, however, is not to tally up marks for a macabre competition; it is precisely the opposite: We need to stop thinking of the two diseases in separate bodies, because a third of the 40 million people living with HIV today are also co-infected with TB.

In 2006 and for at least the next decade, HIV's biggest challenge is TB.

One in every three people harbors the TB bacteria in their body. That's two billion people. TB stays inactive, but transforms into active TB disease in about nine million every year. Crucially, people with HIV are about 30 times more likely to develop active TB than those without HIV-fueling a resurgence of TB in sub-Saharan Africa and some states of the former Soviet Union. East and South Asian countries are next in line.

Imagine the two diseases in one body. Jolting enough to be told you have TB-then to be called back to hear your HIV test was also positive. The doctor is fully aware that TB progresses faster in HIV-infected people, and that TB in those who also have HIV is more likely to be fatal. Their task now is to explain to you that the two diseases often cannot be treated at the same time; the two sets of drugs can interfere with one another.

AllAfrica.com 3/24/06