A new report from the World Health Organization shows that while the total number of new TB cases worldwide remained stable in 2007, and the proportion of people becoming ill with TB continued to fall, the proportion of TB deaths that are HIV related is now thought to be 25 per cent, which is twice as many as previously estimated.

The World Health Organization (WHO) 2009 Global TB Control Report was released on 24 March, to coincide with World TB Day and a gathering of 1,500 delegates attending the 3rd Stop TB Partners’ Forum in Rio de Janeiro, Brazil.

The new report shows that in 2007, there were 1.37 million estimated new TB cases among HIV-infected people and 456,000 deaths worldwide. These figures reflect an improvement in the quality of the data, which is thought to be more representative and available from more countries than ever before.

The report also reveals that one out of every four TB deaths is HIV-related, twice the previous estimate. This is a grave concern not just for for affected individuals but also for public health because HIV speeds up the progress of TB, and drug resistant strains of TB are on the rise.

Dr Margaret Chan, Director-General of WHO said:

“These findings point to an urgent need to find, prevent and treat tuberculosis in people living with HIV and to test for HIV in all patients with TB in order to provide prevention, treatment and care.”

“Countries can only do that through stronger collaborative programmes and stronger health systems that address both diseases,” she added.

The sudden rise in HIV-related TB is likely to be because there has also been a sharp rise in HIV testing among people receiving treatment for TB. African nations show the sharpest rises; in 2004 only 4 per cent of TB patients in Africa were being tested for HIV, in 2007 that figure went up to 37 per cent, with some countries testing for HIV at rates of over 75 per cent of TB patients.

Once a person whose immune system is wrecked by HIV catches TB, they will most likely die within 6 months, Richard Chaisson, director of the Johns Hopkins Center for Tuberculosis Research, told the Washington Post.

“The problem in Africa is HIV patients are not being diagnosed early enough. They die and they die quickly,” said Chaisson.

People with TB can easily be checked for HIV, this only involves taking a saliva test, but it is much harder to check people with HIV for TB, which involves taking a sample of phlegm, and then an X-ray.

Michel Sidibe, Executive Director of UNAIDS, said:

“We have to stop people living with HIV from dying of tuberculosis.”

“Universal access to HIV prevention, treatment, care and support must include TB prevention, diagnosis and treatment. When HIV and TB services are combined, they save lives,” he added.

The report shows that increased testing for HIV among TB patients has led to more people receiving treatment although much fewer than actually need it. In 2007, 300,000 TB patients with HIV started on treatments: two thirds of them on co-trimoxazole treatment to prevent opportunistic infections, and one third on antiretrovirals.

The report shows that of the 9.27 million estimated new cases of TB in 2007, half of them were in India, China, Indonesia, Nigeria and South Africa, and about 57 per cent of the affected individuals are receiving treatment, which involves taking a mixture of different drugs for about six months.

Fighting TB/HIV co-infection and drug resistant TB is one of the greatest challenges we face, said the report. In 2007, of the 500,000 people estimated to have multidrug resistant TB (MDR-TB), less than 1 per cent of them were on treatments that were in line with WHO standards.

Meeting 2009 milestones in the current financial climate is another challenge, and the report mentions increasing concerns about shortage of funds.

To meet the Stop TB Partnership’s Global Plan to Stop TB, the funding shortfall from the 94 countries that carry 93 per cent of the world’s TB burden has gone up to around 1.5 billion US dollars.

The Global Plan aims to cut TB cases and deaths to half the 1990 level by 2015: but this will only happen with full funding, warns the report.

Dr Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said:

“We have made remarkable progress against both TB and HIV in the last few years.”

“But, TB still kills more people with HIV than any other disease,” he added, warning that “the financial crisis must not derail the implementation of the Global Plan to Stop TB.”

“Now is the time to scale-up financing for effective interventions for the prevention, treatment and care of TB worldwide,” urged Kazatchkine.

There is another gathering in Beijing next week to address funding, when health ministers and leaders attend a meeting held by WHO, the Ministry of Health of the People’s Republic of China and the Bill & Melinda Gates Foundation.

“Global tuberculosis control – epidemiology, strategy, financing.”
WHO Report 2009, WHO/HTM/TB/2009.411

Sources: WHO, Washington Post.

Written by: Catharine Paddock, PhD