The HIV-associated tuberculosis epidemic--when will we act?

Hdl Handle:
http://hdl.handle.net/10144/110114
Title:
The HIV-associated tuberculosis epidemic--when will we act?
Authors:
Harries, A D; Zachariah, R; Corbett, E L; Lawn, S D; Santos-Filho, E T; Chimzizi, R; Harrington, M; Maher, D; Williams, B G; De Cock, K M
Journal:
Lancet
Abstract:
Despite policies, strategies, and guidelines, the epidemic of HIV-associated tuberculosis continues to rage, particularly in southern Africa. We focus our attention on the regions with the greatest burden of disease, especially sub-Saharan Africa, and concentrate on prevention of tuberculosis in people with HIV infection, a challenge that has been greatly neglected. We argue for a much more aggressive approach to early diagnosis and treatment of HIV infection in affected communities, and propose urgent assessment of frequent testing for HIV and early start of antiretroviral treatment (ART). This approach should result in short-term and long-term declines in tuberculosis incidence through individual immune reconstitution and reduced HIV transmission. Implementation of the 3Is policy (intensified tuberculosis case finding, infection control, and isoniazid preventive therapy) for prevention of HIV-associated tuberculosis, combined with earlier start of ART, will reduce the burden of tuberculosis in people with HIV infection and provide a safe clinical environment for delivery of ART. Some progress is being made in provision of HIV care to HIV-infected patients with tuberculosis, but too few receive co-trimoxazole prophylaxis and ART. We make practical recommendations about how to improve this situation. Early HIV diagnosis and treatment, the 3Is, and a comprehensive package of HIV care, in association with directly observed therapy, short-course (DOTS) for tuberculosis, form the basis of prevention and control of HIV-associated tuberculosis. This call to action recommends that both HIV and tuberculosis programmes exhort implementation of strategies that are known to be effective, and test innovative strategies that could work. The continuing HIV-associated tuberculosis epidemic needs bold but responsible action, without which the future will simply mirror the past.
Affiliation:
International Union Against Tuberculosis and Lung Disease, Paris, France. adharries@theunion.org
Issue Date:
29-May-2010
URI:
http://hdl.handle.net/10144/110114
DOI:
10.1016/S0140-6736(10)60409-6
PubMed ID:
20488516
Language:
en
ISSN:
1474-547X
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorHarries, A Den
dc.contributor.authorZachariah, Ren
dc.contributor.authorCorbett, E Len
dc.contributor.authorLawn, S Den
dc.contributor.authorSantos-Filho, E Ten
dc.contributor.authorChimzizi, Ren
dc.contributor.authorHarrington, Men
dc.contributor.authorMaher, Den
dc.contributor.authorWilliams, B Gen
dc.contributor.authorDe Cock, K Men
dc.date.accessioned2010-08-21T16:55:24Z-
dc.date.available2010-08-21T16:55:24Z-
dc.date.issued2010-05-29-
dc.identifier.citationThe HIV-associated tuberculosis epidemic--when will we act? 2010, 375 (9729):1906-19 Lanceten
dc.identifier.issn1474-547X-
dc.identifier.pmid20488516-
dc.identifier.doi10.1016/S0140-6736(10)60409-6-
dc.identifier.urihttp://hdl.handle.net/10144/110114-
dc.description.abstractDespite policies, strategies, and guidelines, the epidemic of HIV-associated tuberculosis continues to rage, particularly in southern Africa. We focus our attention on the regions with the greatest burden of disease, especially sub-Saharan Africa, and concentrate on prevention of tuberculosis in people with HIV infection, a challenge that has been greatly neglected. We argue for a much more aggressive approach to early diagnosis and treatment of HIV infection in affected communities, and propose urgent assessment of frequent testing for HIV and early start of antiretroviral treatment (ART). This approach should result in short-term and long-term declines in tuberculosis incidence through individual immune reconstitution and reduced HIV transmission. Implementation of the 3Is policy (intensified tuberculosis case finding, infection control, and isoniazid preventive therapy) for prevention of HIV-associated tuberculosis, combined with earlier start of ART, will reduce the burden of tuberculosis in people with HIV infection and provide a safe clinical environment for delivery of ART. Some progress is being made in provision of HIV care to HIV-infected patients with tuberculosis, but too few receive co-trimoxazole prophylaxis and ART. We make practical recommendations about how to improve this situation. Early HIV diagnosis and treatment, the 3Is, and a comprehensive package of HIV care, in association with directly observed therapy, short-course (DOTS) for tuberculosis, form the basis of prevention and control of HIV-associated tuberculosis. This call to action recommends that both HIV and tuberculosis programmes exhort implementation of strategies that are known to be effective, and test innovative strategies that could work. The continuing HIV-associated tuberculosis epidemic needs bold but responsible action, without which the future will simply mirror the past.en
dc.language.isoenen
dc.rightsReproduced on this site with permission of Elsevier Ltd. Please see [url]http://www.thelancet.com/[/url] for further relevant comment.en
dc.subject.meshAIDS-Related Opportunistic Infectionsen
dc.subject.meshAfrica South of the Saharaen
dc.subject.meshAnti-Infective Agentsen
dc.subject.meshAnti-Retroviral Agentsen
dc.subject.meshAntitubercular Agentsen
dc.subject.meshDisease Outbreaksen
dc.subject.meshGovernment Programsen
dc.subject.meshHIV Infectionsen
dc.subject.meshHealth Facilitiesen
dc.subject.meshHealth Services Needs and Demanden
dc.subject.meshHumansen
dc.subject.meshInfection Controlen
dc.subject.meshIsoniaziden
dc.subject.meshTrimethoprim-Sulfamethoxazole Combinationen
dc.subject.meshTuberculosis, Pulmonaryen
dc.subject.meshWorld Healthen
dc.titleThe HIV-associated tuberculosis epidemic--when will we act?en
dc.contributor.departmentInternational Union Against Tuberculosis and Lung Disease, Paris, France. adharries@theunion.orgen
dc.identifier.journalLanceten

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