UN updates guidelines on joint AIDS-tuberculosis treatment to save more lives

An estimated 910, 000 lives were saved globally in six years due to guidelines intended to ensure that people living with HIV/AIDS are protected from tuberculosis, the United Nations World Health Organization (WHO) said today, releasing an updated policy on joint prevention, diagnosis and treatment of both diseases.

TB is a leading cause of death among people living with HIV/AIDS, which weakens the immune system, making those infected much more susceptible to tuberculosis infection.

Since WHO proposed the initial guidance on collaboration between TB and HIV activities in 2004, the number of people living with HIV screened for TB increased from nearly 200,000 in 2005 to over 2.3 million people in 2010.

Testing for HIV among TB patients surged from 470,000 to over 2.2 million between 2005 and 2010.

“This [new] framework is the international standard for the prevention, care and treatment of TB and HIV patients to reduce deaths; and we have strong evidence that it works,” said Mario Raviglione, the WHO Director of the Stop TB Department. “Now is the time to build on these actions and break the chain that links TB and HIV with death for so many people.”

“We must address TB as we manage HIV,” said Gottfried Hirnschall, Director of WHO’s HIV/AIDS Department.

“We have shown over the last five years what can be done. To continue the progress and save more lives, comprehensive HIV services must include the Three I’s for HIV/TB strategy – isoniazid preventive therapy, intensified screening and infection control for TB – and it should also include earlier treatment for HIV for those that are eligible.”

The main elements of the new policy include:

routine HIV testing for TB patients, people with symptoms of TB, and their partners or family members;

provision of co-trimoxazole, a cost-effective medicine to prevent against lung or other infections for all TB patients who are infected with HIV;

starting all TB patients with HIV on antiretroviral therapy (ART) as soon as possible (and within the first 2 weeks of starting anti-TB treatment) regardless of immune system measurements;

and evidence-based methods to prevent the acquisition of HIV for TB patients, their families and communities.

WHO recommends that those services be provided in an integrated manner, at the same time and place.

More than 100 countries are now testing more than half of their TB patients for HIV. Progress has been especially noteworthy in Africa where the number of countries testing more than half their TB patients for HIV rose from five in 2005 to 31 in 2010.

However, the number of patients co-infected with TB and HIV who are on ART rose gradually from 36 per cent to 46 per cent over the five-year period.